CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
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discussing best practices and guidelines with colleagues;
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having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Concussion Care Pathway
Date of last update: May, 2024
Treatment and Management
Initial Management / Acute Concussion
Clinical Cornerstone:
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A comprehensive approach to managing concussion injury and any associated symptoms involves integrating education, self-care, conservative management, and specific interventions when necessary. This approach should be grounded in evidence-based practice, respectful of cultural nuances, and prioritize patient needs and values. It emphasizes professional collaboration and is continuously fine-tuned based on patient feedback and progress, ensuring a unified, empathetic, and efficient pathway.
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Clinical reason should be used to tailor clinical management to the patient’s individual needs and goals. Reassure patients that symptoms of mild concussions often improve within a month.
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In the event that a concussion is suspected in sport, immediate removal of the player from the field is indicated to avoid further potential injury.
Strategy Details
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Patient Education: Focus on patient understanding of the condition, implementing pain management strategies, and actively participating in the rehabilitation process. Clarify the biopsychosocial dimensions of pain, address underlying psychosocial factors, and underscore the importance of active participation in care and setting realistic expectations. Particularly for concussion patients, written/online information may be a valuable consideration to augment verbal information.
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Assurance regarding Light Activity: Education regarding early (24 to 48 hours post concussion) return to activity and the avoidance of arbitrary bed-rest. Clarify the importance of activity-to-tolerance/relative rest over bed-rest.
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Self-care: Minimize activities associated with a risk of sustaining a subsequent head injury, particularly during the initial management of a concussion. Monitoring for acute complications.
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Exercise: Introduce sub symptom-threshold aerobic exercise within 2 – 10 days. Address fear avoidance behaviours (hurt-vs-harm advice). Clarify the importance of activity-to-tolerance. Discuss incremental activity progressions and graduated return to exercise.
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Return to Work/School: Discuss incremental activity progressions and graduated return to work/school. Address fear avoidance behaviours (hurt-vs-harm advice). Return to work/school decisions should be made in the context of practitioner scope of practice and regional regulations.
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Utilize techniques like Brief Action Planning to support self-management and promote regular movement and engagement in normal activities, including work. Incorporate strategies like goal setting/SMART goals.
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Return to Driving: Patients with concussion should be cautioned about driving within 24 hours post-injury. Consider and discuss the potential impact of any associated symptoms (fatigue/drowsiness, visual disturbances, auditory disturbances, slowed processing/cognition speed, dizziness, confusion, even anxiety/agitation/impulsiveness) on driving safety for the patient and for bystanders. Return to driving decisions should be made in the context of practitioner scope of practice and regional regulations.
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Return to Sport: Discuss incremental activity progressions and graduated return to exercise. Minimize activities associated with a risk of sustaining a subsequent head injury, particularly during the initial management of a concussion (e.g. minimize contact sports, promote mouthguard use in ice hockey). Consider the addition of neuromuscular training warm-up programs to help reduce risk of subsequent headache. Return to sport decisions are complex, and should be made in the context of practitioner scope of practice and regional regulations.
Conduct patient assessment
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Red flags or Orange flags present
Red flags or Orange flags present
Refer to appropriate emergency or healthcare provider
No
Yes
Acute mTBI
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Structured patient education
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Self Care
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Return to work / school
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Return to driving
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Return to sport / activity
Persistent mTBI
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Monitoring and Reassessment
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Tailored clinical management of symptoms:
- Headache
- Neck Pain
- Sleep Disturbance
- Fatigue
- Emotional / Behavioural
- Cognitive Disorders
- Vestibular Disorders
Treatment and management details
Report of findings, Shared decision-making, Initial management, Persistent systems
Differential Diagnosis
Diagnosis
Follow-up
(Align with patient goals, Criteria for discharge)
Major symptom/sign change
Goals not achieved
Discharge
No
Yes
Re-evaluate
Adjust treatment and management plan or refer
References or links to primary sources
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Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. CDC Heads Up [Internet]. CDC February 2022. Available from: https://www.cdc.gov/headsup/index.html.
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David L. MacIntosh Sports Medicine Clinic, University of Toronto. Post-Concussion Return to Activity Guidelines. EMPWR Our Toolkit [Internet]. EMPWR Foundation 2019. Available from: https://empwr.ca/our-toolkit.
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Ontario Psychological Association. OPA Guidelines for Best Practices in the Assessment of Concussions and Related Symptoms [Internet]. OPA July 2016. Available from: https://www.psych.on.ca/getmedia/b7ada02e-76ca-4a5c-891a-bc610c81a213/OPAConcussionGuidelinesFINAL2018.pdf.
Contact information for further inquiries or feedback
carolina.cancelliere@ontariotechu.ca
Disclaimer:
These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.