The Optometric Management of Concussion
Notice bibliographique
Résumé
Traumatic brain injury is a major public health problem that affects millions of people annually and hundreds of people experience brain injury daily. Many of these individuals develop visual symptoms. Optometrists play a prominent role in the management of patients with concussion-associated vision deficits and persistent concussion symptoms. At present, there is no accepted optometric standard of care for individuals with concussion. Patients receiving optometric concussion related care would benefit from a standardized evidence-based concussion management process. \nThe purpose of this project was to determine the current assessment methods and prescribing practices of optometrists seeing individuals with persistent concussion-associated vision deficits in private practice and at a university academic optometry clinic. \n \nStudy 1: \nA retrospective review examined the frequency of visual assessments and management strategies at an academic university optometry clinic. A total of 238 patient files were examined. Of the 238 patient files, 119 individuals had persistent concussion symptoms (concussed group) and 119 individuals did not have concussion (non-concussed cohort). The frequency of visual assessments (ocular structure and visual function) and management strategies were determined. A chi square test was used to compare the frequency of assessments and management strategies between cohorts. In the concussed group, an emphasis on visual function and management strategies, for example assessments of vergence, saccades, pursuits and stereopsis were observed in comparison to the reference group. In non-concussed individuals, ocular structure assessments (e.g., posterior segment, anterior segment and confrontation visual field) were more prevalent than in the concussed cohort. It is important to note that ocular structure assessments did not include assessments conducted by the referring optometrists. Diagnostic drugs, for example tropicamide and anesthetics, were used more commonly in the non-concussed group, while cycloplegia was more prevalent in the concussed group. \n \nStudy 2: \nA 6-question online survey was distributed to optometric provincial and national regulators and associations in Canada. Questions pertaining to visual assessments, prescribed medications and supplements, advice about daily living activity, appointment duration and appointment follow-up were asked. Analysis consisted of binning and determining the frequency of responses. Of the 199 responses received, 142 were completed and analysis was only conducted from these responses. A total of 128 optometrists managed concussion and 13 optometrists did not. The top reasons for optometrists who did not manage concussion was referral and no training. Ocular structure assessments were more prevalent than visual function and management strategies of concussion. Optometrists most frequently recommended Omega 3 (54%) and oral supplements (38%). The majority of optometrist’s (64%) advice on daily living activity was to limit physical and cognitive activity, the second most common suggestion was to rest (12%). The majority of optometrists, 57%, employed 30 to 60-minute assessments and over one-fifth conducted follow-up appointments within 2-months. \nConclusion: \nThis project informs optometrists on the state of concussion management in Canadian private practice and at a university academic optometry clinic. \nFindings can be used to aid in the development of standardized strategies for the optometric management of concussion and related regulatory decisions. This can lead to reductions in persistent post-concussive symptoms, improved patient outcomes, and overall improved quality of life.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».