Delivering virtual group interventions for youth with persisting symptoms after concussion and their caregivers: A pilot study of Move&Connect-Youth and Move&Connect-Caregivers (Preprint)

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Abstract
BACKGROUND Youth with persisting symptoms after concussion (PSaC) can experience ongoing physical, cognitive, and emotional challenges, and their caregivers experience increased stress. There are currently limited interventions that support youth with PSaC or their caregivers. Move&Connect is a virtual group program with two parallel interventions: Move&Connect-Youth (M&C-Y) and Move&Connect-Caregivers (M&C-C). M&C-Y includes concussion education, active rehabilitation, and goal setting. M&C-C uses psychoeducation and practical tools to promote family communication and problem solving. OBJECTIVE We will examine a pilot study of M&C-Y and M&C-C with the objectives of: (1) evaluating intervention fidelity and (2) exploring facilitators and barriers to youth and caregiver engagement. METHODS M&C-Y and M&C-C were delivered virtually using Zoom Healthcare and ran in parallel. Youth with PSaC and caregivers were recruited from a children’s rehabilitation hospital in Ontario, Canada. Intervention fidelity was evaluated according to Bellg’s five principles of fidelity: design, training, delivery, receipt, and enactment. Intervention delivery, attendance and engagement ratings were monitored through weekly logs and fieldnotes. Participants completed exit satisfaction surveys and a subset of youth and caregivers completed semi-structured interviews to understand facilitators and barriers to engagement. Descriptive statistics were used to analyze logs and surveys. Directed content analysis, guided by a motivational framework, and inductive coding to identify barriers and facilitators to engagement was applied to qualitative data. RESULTS A total of 34 youth (M=15.1 years; SD=2.28) and 36 caregivers (M=48.9 years; SD=5.92) completed ten M&C-Y and nine M&C-C groups. Most youth identified as girls (n=24; 71%) and caregivers as mothers (n=30; 83%). Clinician facilitators adhered to the components of the intervention protocols between 97-92% of the time in M&C-Y and 93-82% in M&C-C. The majority of youth (n=22; 65%) and caregivers (n=24; 67%) attended 5 or more sessions. Youth satisfaction was more variable than caregivers’, with 82% of youth and 94% of caregivers agreeing they would recommend the interventions to others. Qualitative findings revealed examples of cognitive, affective, and behavioral engagement. Youth engagement was supported by motivation, comfort in the virtual setting, interactive intervention components, feelings of trust, and diverse and modifiable exercises. Barriers to youth engagement included ongoing symptoms, discrepancies between exercises and physical abilities, and previous knowledge of education. Caregiver engagement was facilitated by perceived benefits of M&C-C, emotional connection and validation, and comfort and convenience of the virtual setting. Barriers to caregiver engagement included high stress, competing scheduling demands, and a lack of reminders or access to intervention materials. CONCLUSIONS The pilot study of M&C-Y and M&C-C was delivered with high fidelity. Exit satisfaction surveys combined with qualitative data revealed high levels of participant satisfaction and engagement with the interventions. Findings demonstrate important implications for delivering virtual group interventions for youth with PSaC and their caregivers. CLINICALTRIAL Trial Registration: NCT05631301

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