Certified Athletic Trainers’ Use of Cervical Clinical Testing in the Diagnosis and Management of Sports-Related Concussion

Abstract

Context: Despite evidence implicating cervicogenic symptoms in the development of persistent postconcussion symptoms, factors that influence utilization of cervical clinical tests to identify cervicogenic symptoms following concussion are poorly understood. Objective: Explore barriers to the utilization of cervical clinical testing in multifaceted concussion evaluation. Design: Cross-sectional. Setting: Online survey. Patients or Other Participants: A total of 122 athletic trainers (AT) (age = 42.6 [6.4] y; female = 51.6%; 52% >10 y of clinical practice; 68% master’s degree or greater; 35% treated a minimum of 15 concussions/y). Main Outcome Measure(s): Perceived importance, clinical experience, number of concussions treated, utilization of cervical clinical tests following nonspecific cervical pathology and following concussion, comfort with cervical treatment modalities following a concussion, and recommendation for cervical-specific therapy to treat persistent postconcussion symptoms. Results: Ordinal logistic regression revealed perceived importance had the strongest positive impact on AT’s likelihood of high utilization of cervical clinical testing following concussion (95% CI, .17 to .99; P = .005), while clinical experience (95% CI, −.43 to .29; P = .71) and number of concussions treated/y (95% CI, −.21 to .31; P = .71) had no bearing. Moreover, low comfort with cervical treatments following a concussion (95% CI, −2.86 to −.26; P = .018) and low utilization of cervical clinical testing following nonspecific cervical pathology (95% CI, −7.01 to −3.39; P ≤ .001) had a strong positive impact on high utilization of cervical clinical testing following concussion. Two logistic regression models demonstrated how recommendations for cervical-specific therapy in persistent post-concussion symptom patients could be predicted based on (1) cervical test utilization and (2) perceptions and clinical experience with 79% and 78%, respectively. Conclusions: Perceived importance played a major role in utilization of cervical clinical test following concussion. ATs who utilized common cervical treatments when dealing with non-concussive injuries were more likely to utilize those same treatments to treat comorbid cervical pathology following a concussion.