Improving access to specialist concussion care through a self-directed, remotely supervised rehabilitation digital health platform: the Birmingham Concussion Home Intervention Programme (B-CHIP)

In the UK each year, >1 million people attend hospital with a head injury, with 1.3 million people living with disabilities as a consequence of traumatic brain injury (TBI), resulting in an estimated £15 billion cost to the UK economy each year1–3. The majority of TBI (80-90%) is categorised as "mild", though its symptoms and implications can be profound, debilitating and long-term. Symptoms include dizziness, headache, neck pain, mental health problems and fatigue, with over one third of patients experiencing persistent symptoms beyond six months4–6. We have recently shown that discharge advice and ongoing care for patients diagnosed with concussion is inadequate and outdated7. This is a severe limitation in the delivery of optimal care to the vast and growing population of affected patients, which can result in symptoms becoming more established and increasingly difficult to eradicate. A number of effective interventions exist for improving concussion symptoms, many of which require only advice and education with remotely-delivered rehabilitation exercises, such as graduated exercise therapy or gaze stabilisation exercises8–12. Early intervention after injury is key to improving recovery, yet identification of patients and provision of specialist care is not performed outside of elite sports settings. Broadening access to such assessment and interventions across the NHS therefore offers a significant opportunity for improving outcomes. To address this urgent need, we are developing a digital health technology (DHT) for improving recovery after concussion. This seeks to serve as an effective intervention which is scalable and accessible, and would be of particular benefit to underserved communities for whom access to specialist care can be challenging. The platform will integrate symptom assessment and offer personalised, targeted rehabilitation exercises based on responses, with remote clinical supervision of progress. This innovation aligns with the scope of this call as a project to develop and test the platform as a mobile app, with the aim of both improving monitoring of brain injury, and enabling rehabilitation specifically aimed at return to normal life . This DHT falls under Tier C of the NICE Evidence Standards Framework for Digital Health Technologies ( Treat ). The innovation is at technology readiness level (TRL) 3. Characteristic proof-of-concept for the assessments and interventions have been demonstrated through optimisation and use in the Birmingham Sports Concussion Clinic13. We have validated electronic patient reported outcomes (ePROs) for clinician monitoring of symptoms in patients with TBI14,15, and have demonstrated that pacing interventions administered within an app are feasible for rehabilitation of chronic symptoms16. We have also demonstrated that a controlled early-exercise program improves concussion recovery12. We have conducted extensive patient and public involvement and engagement (PPIE) and qualitative work with stakeholders to explore and optimise modalities for the collection of symptomatic data for patients with TBI14. Patients with lived experience have been at the centre of the development of this proposal, showing strong support for the technology. Patients particularly note the lack of access to any advice after concussion, and have often felt that they did not know what to do to help their recovery.