Research In Action

We are in the midst of an exciting paradigm shift in the world of pediatric concussion care. After years of relying on a strategy of passive rest as our primary treatment modality, a shift to active strategies has been afoot.

Numerous randomized trials have been published in the past four years demonstrating the benefit of early, active rehabilitation strategies, including aerobic exercise protocols and visio-vestibular therapy to prevent the incidence of prolonged symptoms. Currently, these therapies are primarily prescribed from the specialty care setting, requiring access to a concussion specialist, which can present several challenges to families (including timing and scheduling of in-person visits, transportation to/from and distance of specialty clinics, and insurance coverage, among others).

Towards Equitable Access to Active Therapeutics Following Concussion

While the Minds Matter Concussion Research Program team works to develop the evidence base for active treatment strategies, we are simultaneously pioneering the usage of remote patient monitoring (RPM) to help facilitate their implementation. RPM tools can track the symptoms and activity of concussed youth remotely, rather than relying exclusively on in-person visits to obtain this information.

In a recently published pilot study, we enrolled 30 concussed youth ages 13-18 years from the CHOP emergency department (ED) and monitored them using an RPM approach. We tracked symptom scores of participants with tridaily symptom surveys (delivered to their mobile devices via a smartphone app) and tracked physical activity using wearables. The study found:

• Over 90% of participants interacted with the RPM tool.
• Over 75% of participants responded to our symptom prompts on at least 14 of 21 study days.
• A dynamic incentivization strategy (participant compensation dependent on their response rate) led to higher overall responses than a flat-rate strategy-- an average of 68% of total prompts responded vs. 54%, respectively).
• We were better able to discern recovery at the end of the study period using the RPM tool (93% of participants) as compared to a prospective chart review (30% of participants).

The high degree of engagement with our RPM tool from the ED setting is an exciting finding for us. To take this research a step further, we believe that RPM can be used not just to monitor our patients, but to intervene. RPM has the potential to facilitate care hand-offs from the locations where concussions are primarily diagnosed (primary care offices and EDs) to the specialists, who can prescribe early active rehabilitation strategies for patients who are determined to be at higher risk for prolonged symptoms.

Our team has been working with Conversa Health, an RPM platform, on several new initiatives that will utilize RPM to facilitate these care hand-offs. Ultimately, we feel this approach will allow these exciting, specialized rehabilitation strategies to be available to a much larger and more representative population of concussed children and adolescents.