Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol

Allyssa K Memmini; Michael J Popovich; Kristen H Schuyten; Stanley A Herring; Katie L Scott; James R Clugston; Meeryo C Choe; Christopher M Bailey; M Alison Brooks; Scott A Anderson; Michael A McCrea; Anthony P Kontos; Jessica S Wallace; Johna K Register Mihalik; Tricia M Kasamatsu; Tamara Valovich McLeod; Michelle L Weber Rawlins; Traci R Snedden; Matthew Kaplan; Briana Akani; La'Joya C L Orr; Rebecca E Hasson; Sami F Rifat; Steven P Broglio

doi:10.1007/s40279-022-01788-8

Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol

Sports Med. 2023 Apr;53(4):903-916. doi: 10.1007/s40279-022-01788-8. Epub 2022 Nov 18.

Authors

Allyssa K Memmini^{1

2}, Michael J Popovich³, Kristen H Schuyten⁴, Stanley A Herring⁵, Katie L Scott⁶, James R Clugston^{7

8}, Meeryo C Choe⁹, Christopher M Bailey¹⁰, M Alison Brooks¹¹, Scott A Anderson¹², Michael A McCrea¹³, Anthony P Kontos¹⁴, Jessica S Wallace¹⁵, Johna K Register Mihalik¹⁶, Tricia M Kasamatsu¹⁷, Tamara Valovich McLeod¹⁸, Michelle L Weber Rawlins¹⁹, Traci R Snedden²⁰, Matthew Kaplan²¹, Briana Akani²², La'Joya C L Orr²³, Rebecca E Hasson²³, Sami F Rifat^{24

25}, Steven P Broglio²⁶

Affiliations

¹ Department of Health, Exercise and Sports Sciences, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA. amemmini@unm.edu.
² Concussion Center, University of Michigan, Ann Arbor, MI, USA. amemmini@unm.edu.
³ Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
⁴ MedSport Physical Therapy, Michigan Medicine, Ann Arbor, MI, USA.
⁵ Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
⁶ Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL, USA.
⁷ Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA.
⁸ Department of Neurology, University of Florida, Gainesville, FL, USA.
⁹ Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
¹⁰ Department of Neurology, Case Western Reserve School of Medicine/University Hospitals, Cleveland, OH, USA.
¹¹ Department of Orthopedics & Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.
¹² Department of Athletics, University of Oklahoma, Norman, OK, USA.
¹³ Department of Neurosurgery, Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁴ Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁵ Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA.
¹⁶ Matthew Gfeller Center and STAR Heel Performance Laboratory, Department of Exercise and Sport Science, The University of North Carolina Chapel Hill, Durham, NC, USA.
¹⁷ Department of Kinesiology, California State University, Fullerton, CA, USA.
¹⁸ Athletic Training Programs, A.T. Still University, Mesa, AZ, USA.
¹⁹ School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA.
²⁰ School of Nursing, University of Wisconsin-Madison, Madison, WI, USA.
²¹ Center for Research on Learning & Teaching, University of Michigan, Ann Arbor, MI, USA.
²² College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA.
²³ School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
²⁴ University of Michigan Athletics, Ann Arbor, MI, USA.
²⁵ Department of Orthopaedics, Cleveland Clinic, Cleveland, OH, USA.
²⁶ Concussion Center, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education.

Objective: To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery.

Methods: Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings.

Results: Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol.

Conclusion: There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders.

MeSH terms

Adolescent
Athletic Injuries* / diagnosis
Brain Concussion* / diagnosis
Delphi Technique
Female
Humans
Male
Sports*
Universities
Young Adult

Grants and funding

Rackham Graduate Student Research Grant/Horace H. Rackham School of Graduate Studies, University of Michigan