Retrospective Examination of Referral Patterns to Physical Therapy After Concussion: Have We Kept Up With Current Guidelines?

OBJECTIVE

The study goals were to (1) identify the typical time from a concussion injury to initial physical therapy (PT) evaluation, and (2) explore concussion subtypes (complexity) across time (diagnosis visit vs PT evaluation). We anticipated the median time from concussion to PT evaluation would be 61 days, and that a greater time from injury to PT evaluation would be associated with greater symptom complexity. We also explored demographics and referral patterns to PT.

DESIGN

Retrospective chart review.

SETTING

Academic medical center.

PARTICIPANTS

A convenience sample of patients seen in PT for concussion from March 1, 2023 to December 31, 2024 with no hospitalization from concussion and no skull fracture. Two hundred and four charts were reviewed, and 100 met the inclusion criteria (N = 100). Patients were 46.0 (±15.0) years old and 67% women. The most common mechanism of injury was a motor vehicle accident (43%).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Days from concussion injury to initial PT evaluation, number of concussion subtypes (range, 0-7) at diagnosis and PT evaluation, departments diagnosing concussion and referring to PT, and mechanism of injury.

RESULTS

The median (range) time from injury to diagnosis was 5 (0-64) days, and the median time to PT evaluation was 58 (5-339) days. The mean number of subtypes at diagnosis was 3.24 (±1.59), which was significantly less than at PT evaluation, which was 4.32 (±1.36). There was no association between the number of subtypes and days to PT evaluation. Primary care provided the most diagnoses and referrals to PT, followed by emergency department (diagnosis) and sports medicine (referrals).

CONCLUSIONS

The time to PT evaluation was similar to that found in other studies conducted before publication of recent concussion guidelines. This continued delay in being seen by PT may be because of lack of awareness of concussion guidelines by non-specialty providers, and limited availability of concussion specialist therapists contributing to long appointment wait times.