TY  - JOUR
AU  - Shore, Josh
AU  - Nalder, Emily
AU  - Hutchison, Michael
AU  - Reed, Nick
AU  - Hunt, Anne
PY  - 2022
DA  - 2022/4/4
TI  - Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development
JO  - JMIR Pediatr Parent
SP  - e34822
VL  - 5
IS  - 2
KW  - concussion
KW  - pediatrics
KW  - active rehabilitation
KW  - telehealth
KW  - exercise
KW  - mobile phone
AB  - Background: Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective: This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods: The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results: Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions: The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach. 
SN  - 2561-6722
UR  - https://pediatrics.jmir.org/2022/2/e34822
UR  - https://doi.org/10.2196/34822
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35377326
DO  - 10.2196/34822
ID  - info:doi/10.2196/34822
ER  -