Stanford Advisors

All Publications

  • Implementation of Concussion Management Policies in High Schools: The Critical Role of School Nurses. The Journal of school nursing : the official publication of the National Association of School Nurses Hess, C. W., Howland, J., Hackman, H., Campbell, J. K., Vannoy, S., Hayden, L. 2023: 10598405231160249


    Evidence-based practices in concussion management (CM) have been codified into legislation. However, legislation is varied, and implementation is narrowly evaluated. School nurses hold a unique position to assess the implementation of health policies. The implementation of concussion management policies across Massachusetts high schools was evaluated by the school nurse. A cross-sectional survey was sent to school nurses (N=304), and responses (n=201; 68.1% response rate) were tallied whereby higher scores indicated more practices being implemented. One open-text question was included to encourage nurses to provide context regarding implementation in their school. Descriptive statistics and thematic analysis were used to assess current implementation and nursing perspectives. Findings indicate that the degree of implementation varies, and some nurses reported difficulty with mobilizing clinical uptake of concussion management practices in their schools. Further implementation research is needed, and school nurses are an important stakeholder to include when assessing the clinical uptake of concussion management policies in schools.

    View details for DOI 10.1177/10598405231160249

    View details for PubMedID 36916285

  • Enhancing Exposure Treatment for Youths With Chronic Pain: Co-design and Qualitative Approach. Journal of participatory medicine Schemer, L., Hess, C. W., Van Orden, A. R., Birnie, K. A., Harrison, L. E., Glombiewski, J. A., Simons, L. E. 2023; 15: e41292


    Increasing the access to and improving the impact of pain treatments is of utmost importance, especially among youths with chronic pain. The engagement of patients as research partners (in contrast to research participants) provides valuable expertise to collaboratively improve treatment delivery.This study looked at a multidisciplinary exposure treatment for youths with chronic pain through the lens of patients and caregivers with the aim to explore and validate treatment change processes, prioritize and develop ideas for improvement, and identify particularly helpful treatment elements.Qualitative exit interviews were conducted with patients and caregivers at their discharge from 2 clinical trials ( NCT01974791 and NCT03699007). Six independent co-design meetings were held with patients and caregivers as research partners to establish a consensus within and between groups. The results were validated in a wrap-up meeting.Patients and caregivers described that exposure treatment helped them better process pain-related emotions, feel empowered, and improve their relationship with each other. The research partners developed and agreed upon 12 ideas for improvement. Major recommendations include that pain exposure treatment should be disseminated more not only among patients and caregivers but also among primary care providers and the general public to facilitate an early referral for treatment. Exposure treatment should allow flexibility in terms of duration, frequency, and delivery mode. The research partners prioritized 13 helpful treatment elements. Most of the research partners agreed that future exposure treatments should continue to empower patients to choose meaningful exposure activities, break long-term goals into smaller steps, and discuss realistic expectations at discharge.The results of this study have the potential to contribute to the refinement of pain treatments more broadly. At their core, they suggest that pain treatments should be disseminated more, flexible, and transparent.

    View details for DOI 10.2196/41292

    View details for PubMedID 36892929

  • Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design. JMIR research protocols Simons, L. E., Hess, C. W., Choate, E. S., Van Orden, A. R., Tremblay-McGaw, A. G., Menendez, M., Boothroyd, D. B., Parvathinathan, G., Griffin, A., Caruso, T. J., Stinson, J., Weisman, A., Liu, T., Koeppen, K. 2022; 11 (12): e40705


    BACKGROUND: Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain.OBJECTIVE: This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design.METHODS: This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice.RESULTS: The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024.CONCLUSIONS: Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR.TRIAL REGISTRATION: NCT04636177; REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40705.

    View details for DOI 10.2196/40705

    View details for PubMedID 36508251

  • Targeting Pain Science Education in Youth with Chronic Pain: What are the Sticking Points for Youth and Their Parents? The Clinical journal of pain Pate, J. W., Harrison, L. E., Hess, C. W., Moseley, G. L., Rush, G., Heathcote, L. C., Simons, L. E. 2022


    An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps.Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8-18 years, and their parents, completed a series of questionnaires.Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth (r=.32) suggests that the COPI is sensitive to cognitive development and/or life experiences. Youth and parent COPI responses were weakly associated (r=0.24), highlighting the importance of targeting concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention, that could potentially lead to greater engagement with multidisciplinary pain treatment.The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain via pain science education. Future research should determine the utility of the COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.

    View details for DOI 10.1097/AJP.0000000000001088

    View details for PubMedID 36453624

  • Looking inward to improve pediatric chronic pain outcomes: a call for team science research. Pain Hess, C. W., Rosen, M. A., Simons, L. E. 2022

    View details for DOI 10.1097/j.pain.0000000000002836

    View details for PubMedID 36637136

  • Application of painDETECT in Pediatric Chronic Pain: How Well Does It Identify Neuropathic Pain and Its Characteristics? Van Orden, A., Hess, C. W., Mesaroli, G., Stinson, J., Borsook, D., Simons, L. E. CHURCHILL LIVINGSTONE. 2022: 51
  • Lived Experiences of an Elite Performance Management Team Through Injury Rehabilitation: An Interpretative Phenomenological Analysis JOURNAL OF SPORT REHABILITATION Hess, C. W., Meyer, B. B. 2022; 31 (2): 199-210


    Injury is a common and challenging experience for many athletes, and return-to-sport outcomes have been persistently poor despite advancements in research and practice. To ameliorate this challenge and to bridge a gap that exists in the sport injury literature between theoretical conceptualization and intervention design, research is needed to explore team-based approaches to professional practice. The current study aimed to begin this work through exploration of a single performance management team (PMT) through 2 injury and rehabilitation cases leading into and across the 2014 Olympic Winter Games.Qualitative, interpretative phenomenological analysis.Interviews were conducted with the 5 members of the PMT (coach, physiotherapist, sport psychology consultant, case manager, and athlete) involved in both injury cases. Lower-order and higher order themes were identified and interpreted through the extent literature.Results indicate that 3 higher order themes interacted to impact the lived experiences of the PMT members across the 2 injury cases. Participants described the sociocultural context that surrounded the team, the individual struggles they faced, and the functioning of the team as the primary contributors to their lived experiences as well as observed rehabilitation outcomes.Findings of this study mirror previous research in team science within the general health care domain, and prompt ongoing exploration of how to improve the experiences for PMT members as well as rehabilitation and return-to-sport outcomes for athletes.

    View details for DOI 10.1123/jsr.2021-0072

    View details for Web of Science ID 000791037300010

    View details for PubMedID 34784584