Para Sport Healthcare Providers’ Perspectives on the Concussion Continuum of Care

Context: Para sport includes diverse athletes with varying impairment classifications. Current sport-related concussion (SRC) guidelines have limited para athlete considerations, which alters how healthcare providers (HCPs) serve athletes and warrants inquiry. Purpose: To understand HCPs’ practices and perspectives for treating para athletes diagnosed with SRCs. Methods: Using an exploratory mixed-method design, para sport HCPs caring for athletes with various impairment classifications and sports (e.g., wheelchair basketball) completed a validated web-based survey (n=21) and participated in semi-structured virtual interviews (n=11) discussing their experiences managing para athletes with SRCs. We calculated frequencies for survey responses and analyzed interview transcripts via phenomenology using multi-analyst triangulation and peer review as credibility strategies. Results: HCPs noted a median experience managing 2.5 SRCs (range=0-104) per year across multiple sports. Most HCPs used the Sport Concussion Assessment Tool 6 (SCAT6) (85.7%) to guide examinations. The modified Balance Error Scoring System (mBESS; 66.7%), BESS (57.1%), or Wheelchair Error Scoring System (WESS; 52.4%) were used for balance testing. HCPs used VOMS (81.0%) or King-Devick (38.1%) for vestibular ocular-motor testing. HCPs noted the importance of developing classification-based and/or sport-based protocols for para athletes with intentional flexibility to promote individualized concussion healthcare. Building personal relationships with athletes helped providers determine whether reported signs and symptoms were concussion-related or due to pre-existing impairments (e.g., visual impairments). Multidisciplinary care was critical for successful management as the level of care varied widely across para sports due to limited education, access to resources, and funding available for providers who are often volunteers. Conclusion: Para sport HCPs were receptive and used current SRC assessment tools, but reported a lack of effective adaptive guidelines as noted by variable athlete-specific modifications for SRC assessments and return-to-sport guidelines. Our findings emphasize the importance of developing and implementing ecologically valid para sport SRC healthcare.