American Headache Society white paper on treatment of post-traumatic headache from concussion in youth.

OBJECTIVE: To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury. BACKGROUND: Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. METHODS: This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. RESULTS: Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. CONCLUSIONS: This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.

Assessing Student Performance Using a Novel Rubric Based on the Dreyfus Model of Skill Acquisition.

OBJECTIVE: Pharmacy student performance on practicum was previously assessed using a Likert scale from 0 to 9, resulting in challenges with clarity and assessor subjectivity. To address these issues, an assessment rubric based on the Dreyfus model of skill acquisition was developed and implemented. This study sought to evaluate student, practice educator (PE), and faculty perceptions related to the rubric's effectiveness in assessing student performance within the direct patient care practicum setting. METHODS: An exploratory sequential mixed methods approach was used. A qualitative component using focus groups and semistructured interviews was followed by a quantitative component using a survey questionnaire. Data gathered from the qualitative component were collectively analyzed and used to inform questionnaire development intended to confirm identified themes and collect further data on stakeholder perceptions. RESULTS: A total of 7 students, 7 PEs, and 4 faculty participated in the focus groups/interviews and 70 of 645 (10.9%) students and 103 of 756 (13.6%) PEs participated in the survey questionnaire. The majority of the participants felt that the rubric clearly communicated the expectations for student performance, is relevant and consistent with pharmacy practice, and is useful in accurately assessing performance. For PEs with experience, the novel rubric was an improvement over the previous assessment processes and perceived as more thorough and clearer in describing performance expectations. The identified challenges included the rubric's visual organization, length, and redundancy of some of the assessment elements. CONCLUSION: Our findings suggest that a novel rubric based on the Dreyfus model is effective in assessing student performance on practicum and may address some of the challenges commonly observed with performance assessment.

US physical therapist practice patterns evaluating concussion and clinical practice guideline adherence.

OBJECTIVES: To assess the influence of contemporary physical therapy clinical practice guidelines (CPG) on concussion evaluation practice patterns and barriers/facilitators for CPG adherence. DESIGN: Electronic cross-sectional survey. SETTING: Online survey platform. PARTICIPANTS: US licensed physical therapists that manage concussion. MAIN OUTCOME MEASURES: 1) practice patterns 2) knowledge/use of CPG 3) barriers/facilitations to CPG adherence. RESULTS: Knowledge/use of CPG categories significantly predicted the model (χ2(1) = 10.966, p < .001) of total vignette scores/practice patterns with a statistically significant effect. A Kruskal-Wallis test indicated significant differences in total vignette score means based on knowledge/use between "not aware of the concussion CPG" and "integrated concussion CPG into practice" groups (p < .001, ES = .21). Knowledge/use of the CPG predicted the perceived barriers/facilitators model for three questions: investment in specialized concussion training (χ2(1) = 39.52, p < .001), necessary equipment to complete concussion evaluation (χ2(1) = 16.01, p < .001), and confidence around concussion evaluation knowledge (χ2(1) = 27.46, p < .001) with a significant effect. CONCLUSION: The results of this study provide support for guiding documents like the CPG to positively influence concussion practice patterns and insight into facilitators for guideline adherence.

The intersection of COVID-19, school, and headaches: Problems and solutions.

OBJECTIVE: To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders. BACKGROUND: COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually. METHODS: Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. RESULTS: We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. CONCLUSION: Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.