An Inside Look at Para Sport Concussion Care: Para Sport Health Care Providers' Perspectives.

CONTEXT: Para sport athletes experience concussions at a similar rate to athletes without disabilities; however, published concussion tools have limited applicability to diverse athlete populations. OBJECTIVE: To understand health care provider (HCP) concussion management across different para sports and athlete classifications to identify facilitators and barriers influencing the delivery of concussion care. DESIGN: Cross-sectional study. SETTING: Online survey and virtual interviews. PATIENTS OR OTHER PARTICIPANTS: Para sport HCPs completed online surveys (n = 21) and voluntary follow-up interviews (n = 11). DATA COLLECTION AND ANALYSIS: Researchers designed a survey from an established line of health care evaluation surveys and distributed it via chain-referral sampling following expert review (n = 3) and pilot testing (n = 4). We conducted follow-up interviews via Google Meet using automatic transcription technology and reviewed for accuracy. We used phenomenology to analyze the qualitative data with multianalyst triangulation and peer review as credibility strategies. RESULTS: Health care providers most often used the Sport Concussion Assessment Tool 6 (85.7%) to guide examinations, the modified Balance Error Scoring System (66.7%) for balance testing, and the Vestibular/Ocular-Motor Screening (81.0%) for vestibular ocular-motor testing. Health care providers noted 3 themes: (1) the importance of developing purposefully flexible classification- and para sport-specific frameworks to promote individualized concussion care while (2) building personal HCP-athlete relationships to understand individual needs and improve concussion diagnostics and emphasizing (3) a multidisciplinary, team-based approach to care. Health care providers emphasized these themes as critical for successful management across para sports to overcome limited education and resource allocation available to often volunteer-based HCPs. CONCLUSIONS: Para sport HCPs used current concussion assessment tools but reported a lack of effective adaptive guidelines exemplified by variable athlete-specific modifications for concussion care. Our findings emphasize the need to develop flexible frameworks for para sport concussion management while emphasizing a multidisciplinary, team-based approach to care and HCP-athlete relationships to implement effective para sport concussion care.