Specialist Healthcare Services for Concussion/Mild Traumatic Brain Injury

Abstract

Mild traumatic brain injuries (TBIs) affect over a million people in England and Wales annually. While most individuals recover spontaneously within days to weeks, a significant proportion experience persistent symptoms that last months to years after injury. These symptoms are complex and heterogenous, affecting daily functioning, return to work or play, and quality of life. Patients with persistent symptoms have extended healthcare needs requiring ongoing care in outpatient services. However, guidance on mild TBI care in the outpatient setting is limited, and the standard of care in England remains unclear. This thesis aims to address how to plan care provision and service delivery for individuals with persistent symptoms after a mild TBI, focusing on their healthcare needs. This thesis presents exploratory research using a mixed-method approach, drawing on survey data. The first component evaluated the impact of head injuries on university student athletes to inform safety and return to play protocols and evaluate how to enhance clinical and university-based support services. Subsequently, current clinical practices and unmet healthcare needs were examined through quantitative and qualitative data. Solutions for planning care provision and service delivery based on healthcare needs were evaluated, and a consensus study was conducted to establish agreement on care provision and service delivery for specialist outpatient services. Additionally, the feasibility of using digital health interventions to identify individuals with persistent symptoms after a mild TBI and triage them to multidisciplinary clinics based on healthcare needs was assessed. These results highlight clear unmet healthcare needs in the mild TBI population with persistent symptoms. Improved safety and return to play protocols are necessary for student athletes, and students with persistent symptoms would benefit from improved support services, both clinical and educational. Current healthcare provision and service delivery are suboptimal, lacking capacity, and offering limited value to patient health. To address these needs and improve care quality, structured follow-up in multidisciplinary clinics should be made available and accessible to deliver appropriate and timely care. This requires adequate resource allocation and sufficient capacity in specialist outpatient services. Standardising multidisciplinary management is crucial to addressing the diverse needs within the population, but more comprehensive clinical practice guidelines are necessary to deliver high-value care. Services and guidelines should be integrated into a care pathway that extends from the acute phase through to achieving the desired outcome. A clear pathway to access these services is necessary, and this may feasibly be delivered using digital health tools. Further evidence is needed to evaluate the cost-effectiveness and clinical value of such services. This thesis provides the foundation for planning care provision and service delivery for specialist outpatient services based on healthcare needs in the mild TBI population. Future work should establish the definitions of concussion/mild TBI and persistent symptoms, planning the care pathway, and implementing evidence-based recommendations and effective interventions to improve the quality of care and patient outcome.