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Pilot survey regarding “the green folder” – an educator-designed secondary school return to learn protocol after a sport-related concussion
  1. James D Carson1,
  2. Aliya Safwan2,
  3. Sari A Kraft3,
  4. Nariko Kuwahara3,
  5. Stefanie E Moser4,
  6. Sarah T Rabinovitch4,
  7. Qurat-ul-Ain Mansoora5,
  8. Vijitha Jegatheesan6,
  9. Rahim Moineddin1,
  10. Pierre Fremont7
  1. 1University of Toronto, Toronto, ON, Canada
  2. 2Fatima Jinnah Medical College, Lahore, Pakistan
  3. 3Western University, London ON
  4. 4Sheridan College, Oakville, ON, Canada
  5. 5Aureus University, School of Medicine, Aruba
  6. 6University of Jaffna, Sri Lanka
  7. 7Universit Laval, Qubec, Qubec, Canada


Objective To demonstrate whether a user-centred (teacher accepted and student focused) return to learn (RTL) protocol after a sport-related concussion (SRC)has an efficacious role.

Design Prospective pilot survey.

Setting Four sport medicine clinics in Ontario, Canada.

Participants Twenty-eight collegiate athletes (21 males and 7 females: age=20.2 ± 1.7 years, height=182.2 ± 11.9 cm, mass=90.3 ± 24.2 kg) without history of: headaches or migraines, substances/alcohol abuse, and/or psychiatric conditions.

Intervention NineSRC students from one (index) school who used the new protocol and a control group (11 SRC students) from other schools, who did not use the new protocol,completed a web-based survey.

Outcome measures Primary outcome measures include student perception of school support during their SRC RTL.

Main results Twenty surveys were completed from an eligible 52 students (38.5%).Among students who received the Green Folder at the index school, 71.4% either strongly or mostly agreed thatsuch an RTL protocol could shorten the duration of SRC symptoms. At that school, 100% strongly or mostly agreed (versus 14.3% from the other schools) that the school was very helpful advising about the RTL steps and when they should return to school. 85.7% of students at the index school versus 28.6% from other schools, strongly or mostly agree that the school staff fully understands RTL strategies after SRC.

Conclusions The “Green Folder” incorporating RTL steps and a daily class-by-class accommodation sign off by a guidance counsellor, appears to have perceived efficacy for SRC students. Further research will determine whether such a user-centred RTL protocol results in a more efficacious implementation of expert recommendations about concussion management, worthy of widespread dissemination.

Competing interests None.

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