Return-to-Learn for the K-12 Student: a Mixed-Methods Systematic Review.

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Our aim was to perform a systematic review of Return-to-Learn literature with the intent of determining what items are necessary to form a comprehensive Return-to-Learn policy. We searched CINAHL, Embase, PubMed, Scopus, Google Scholar, and WorldWideScience.org using 25 search terms including return to learn, adolescents, concussion management, concussion AND children, concussion AND department of education, concussion AND secondary schools, concussion AND middle school, concussion AND primary school, concussion AND policy AND procedures, concussion AND 504 plans. Eligible studies were (i) published between 2009 and 2022; (ii) originally published in English in a peer-reviewed journal; (iii) have a full text available; (iv) discuss the K-12 population; (v) contain one of the following terms in the body of the document: Return to Learn, RTL, Return to School, Return to Classroom, or Return to Academics; (vi) identify RTL as a primary aim of the document. The Qualitative Assessment and Review Instrument and JBI Meta-Analysis of Statistics Assessment and Review Instrument tools were used to extract data from eligible studies. Extraction occurred independently by two researchers. Review yielded 32,766 articles, with 58 meeting inclusion criteria. Two qualitative themes and five subthemes aggregated with six quantitative narratives to produce five converged findings: 1) members and point person, 2) overcoming barriers to communication, 3) increasing concussion knowledge and training in the school system, 4) recommendations in the classroom, and 5) tackling the invisible injury. Less than one-third of included articles reported data from younger (K-8) cohorts, therefore, the converged findings represent significant facets of high school Return-to-Learn that stakeholders should embed into novel and revised state concussion legislation. Subsequent efforts should seek to appraise current state Return-to-Learn laws for existing use of evidence-based practice and begin accumulating data specific to younger students and school professionals that monitor and teach these individuals such that commensurate policy recommendations can then be made.