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

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.

PMID: 36396900
PMCID: PMC9672536
DOI: 10.1007/s40279-022-01788-8

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

Allyssa K Memmini et al. Sports Med. 2023 Apr.

. 2023 Apr;53(4):903-916.

doi: 10.1007/s40279-022-01788-8. Epub 2022 Nov 18.

Authors

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.

PMID: 36396900
PMCID: PMC9672536
DOI: 10.1007/s40279-022-01788-8

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.

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Conflict of interest statement

Dr. Steven Broglio has current or previous research funding from the National Institutes of Health, Centers for Disease Control and Prevention, and Department of Defense (U.S.A. Medical Research Acquisition Activity), National Collegiate Athletic Association, National Athletic Trainers’ Association Foundation, National Football League/Under Armour/GE, Simbex, and ElmindA; is a co-author of Biomechanics of Injury (3^rd edition, Human Kinetics); serves as a consultant for U.S. Soccer (paid), U.S. Cycling (unpaid), medico-legal litigation; received speaker honorarium and travel reimbursements for his research presentations; and has a patent pending on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (U.S. Application No. 17/164,490). Under Dr. Steven Broglio’s direction, Dr. Allyssa Memmini has secured funding from the University of Michigan Rackham Graduate Research Grant. Dr. Meeryo Choe serves as a speaker for pediatric grand rounds and consultant for medico-legal litigation. Dr. Anthony Kontos receives royalties from APA Books and support for research to the University of Pittsburgh from the National Football League. Dr. Johna Register Mihalik received research funding to The University of North Carolina-Chapel Hill in the past three years from the National Football League, Department of Defense, Centers for Disease Control and Prevention, National Athletic Trainers’ Association Foundation, and the NCAA-DoD Mind Matters Research Challenge, as well as previously served on USA Football’s Football Development Council. All Delphi panelists received $50 as an incentive for their participation in this study.

Figures

**Fig. 1**
Overview of Delphi procedure. The Delphi procedure was comprised of three total rounds (including a preparatory phase). Panelists were asked to complete an open-ended questionnaire (Round 1) resulting in 42 content statements. During Round 2, panelists rated each statement by level of importance. By Round 3, panelists had the opportunity to review their individual responses relative to the group and adjust their scores if desired. ^aNo change in number of statements after Round 2 (all statements rated > 3). ^bStatements were considered to achieve consensus if they earned a group mean score ≥ 7 after Round 3

See this image and copyright information in PMC

References

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

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous