A streamlined approach to identifying adults suited to neck rehabilitation following concussion: a feasibility study.

Individuals will be screened by a musculoskeletal physiotherapist specialising in clinical management of concussion for clinical indicators inferring referal for orthopedic musculoskeletal physiotherapy management (of the cervical spine) acutely following concussion is indicated. Screening procedures are based on clinical diagnostic rules used for musculoskeletal disorders of the neck. Published clinical diagnositic rules for identification of neck disorders require evidence of a combination of physical signs of neck impairment including but not limited to, positive findings on manual examination and or palpatino of the neck, limitations in available active range of neck motion, and or impaired neuromusclular performance. Best practice guidelines for concussion management (See Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022 and Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review; published 2023) support multidimensional assessment and management of the neck and sensorimotor (specifically vestibulo occular) systems, where identification of impairment post-injury is identified. Hence development of the physical screen is based on this and treatment will be patient centred, pragmatic in nature, and in accord with current best practice guidelines. . Once screened and identified as appropriate for neck rehabilitation, participants will be offered four weeks of treatment with a musculoskeletal phyisotherapists. A maximum of 2 one on one treatment sessions will be available each week. Treatment sessions will be of 30 minutes duration with exception of the first treatment session where participants will complete the Buffalo Concussion Treadmill Test to identify maximal heart rate levels for daily acitivity, in accord with best pactice guidelines for concussion management. Determination of treatment frequency will be made by the treating physiotherapist, in accord with a pragmatic intervention approach. Participants will be required to complete a daily record of compliance with their home exercise program for the duration of their treatment. Exercise which will be prescribed includes a daily walking regime at a target heart rate, based on best practice guidelines. Examples of exercises specific to cervical spine which may be included in participant home exercise programs include: range of motion, proprioceptive or neuromuscular exercises. Participants may be discharged before completion of the four weeks of treatment at the discretion of the treating physiotherapist in accord with a pragmatic treatment approach. The treating physiotherapist will record any missed treatment sessions. The main aim of the study is to determine feasibility of the study design rather than explicit treatment effect.