Catherine Chan1, Grant L Iverson2, Jacqueline Purtzki3, Kathy Wong4, Vivian Kwan5, Isabelle Gagnon6, Noah D Silverberg7. 1. GF Strong Rehab Centre, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada. 2. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA; MassGeneral Hospital for Children Sport Concussion Program, Boston, MA. 3. GF Strong Rehab Centre, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada. 4. GF Strong Rehab Centre, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada. 5. University of Calgary, Calgary, Alberta, Canada. 6. McGill University, Montreal, Quebec, Canada; Montreal Children's Hospital, Montreal, Quebec, Canada. 7. Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada. Electronic address: noah.silverberg@vch.ca.
Abstract
OBJECTIVES: To examine the safety and tolerability of an active rehabilitation program for adolescents who are slow to recover from a sport-related concussion, and secondarily to estimate the treatment effect for this intervention. DESIGN: Single-site, parallel, open-label, randomized controlled trial comparing treatment as usual (TAU) to TAU plus active rehabilitation. SETTING:Outpatient concussion clinic. PARTICIPANTS: Adolescents (N=19) aged 12 to 18 years with postconcussion symptoms lasting ≥1 month after a sports-related concussion. INTERVENTIONS: TAU consisted of symptom management and return-to-play advice, return-to-school facilitation, and physiatry consultation. The active rehabilitation program involved in-clinic subsymptom threshold aerobic training, coordination exercises, and visualization and imagery techniques with a physiotherapist (mean, 3.4 sessions) as well as a home exercise program, over 6 weeks. MAIN OUTCOME MEASURES: A blinded assessor systematically monitored for predetermined adverse events in weekly telephone calls over the 6-week intervention period. The treating physiotherapist also recorded in-clinic symptom exacerbations during aerobic training. The Post-Concussion Symptom Scale was the primary efficacy outcome. RESULTS:Nineteen participants were randomized, and none dropped out of the study. Of the 12 adverse events detected (6 in each group), 10 were symptom exacerbations from 1 weekly telephone assessment to the next, and 2 were emergency department visits. Four adverse events were referred to an external safety committee and deemed unrelated to the study procedures. In-clinic symptom exacerbations occurred in 30% (9/30) of aerobic training sessions, but resolved within 24 hours in all instances. In linear mixed modeling, active rehabilitation was associated with a greater reduction on the Post-Concussion Symptom Scale than TAU only. CONCLUSIONS: The results support the safety, tolerability, and potential efficacy of active rehabilitation for adolescents with persistent postconcussion symptoms.
RCT Entities:
OBJECTIVES: To examine the safety and tolerability of an active rehabilitation program for adolescents who are slow to recover from a sport-related concussion, and secondarily to estimate the treatment effect for this intervention. DESIGN: Single-site, parallel, open-label, randomized controlled trial comparing treatment as usual (TAU) to TAU plus active rehabilitation. SETTING:Outpatient concussion clinic. PARTICIPANTS: Adolescents (N=19) aged 12 to 18 years with postconcussion symptoms lasting ≥1 month after a sports-related concussion. INTERVENTIONS: TAU consisted of symptom management and return-to-play advice, return-to-school facilitation, and physiatry consultation. The active rehabilitation program involved in-clinic subsymptom threshold aerobic training, coordination exercises, and visualization and imagery techniques with a physiotherapist (mean, 3.4 sessions) as well as a home exercise program, over 6 weeks. MAIN OUTCOME MEASURES: A blinded assessor systematically monitored for predetermined adverse events in weekly telephone calls over the 6-week intervention period. The treating physiotherapist also recorded in-clinic symptom exacerbations during aerobic training. The Post-Concussion Symptom Scale was the primary efficacy outcome. RESULTS: Nineteen participants were randomized, and none dropped out of the study. Of the 12 adverse events detected (6 in each group), 10 were symptom exacerbations from 1 weekly telephone assessment to the next, and 2 were emergency department visits. Four adverse events were referred to an external safety committee and deemed unrelated to the study procedures. In-clinic symptom exacerbations occurred in 30% (9/30) of aerobic training sessions, but resolved within 24 hours in all instances. In linear mixed modeling, active rehabilitation was associated with a greater reduction on the Post-Concussion Symptom Scale than TAU only. CONCLUSIONS: The results support the safety, tolerability, and potential efficacy of active rehabilitation for adolescents with persistent postconcussion symptoms.
Authors: Vicki Anderson; Vanessa C Rausa; Nicholas Anderson; Georgia Parkin; Cathriona Clarke; Katie Davies; Audrey McKinlay; Ali Crichton; Gavin A Davis; Kim Dalziel; Kevin Dunne; Peter Barnett; Stephen Jc Hearps; Michael Takagi; Franz E Babl Journal: BMJ Open Date: 2021-02-11 Impact factor: 2.692