John J Leddy1, Andrea L Hinds, Jeffrey Miecznikowski, Scott Darling, Jason Matuszak, John G Baker, John Picano, Barry Willer. 1. From the *UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Buffalo, New York;†Department of Biostatistics, SUNY Buffalo, Buffalo, New York;‡Excelsior Orthopedics and the Department of Family Medicine, SUNY Buffalo, Buffalo, New York;§Nuclear Medicine, SUNY Buffalo, Buffalo, New York;¶Department of Internal Medicine, SUNY Buffalo, Buffalo, New York; and‖Department of Psychiatry, SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Abstract
OBJECTIVE: To evaluate (1) systematic assessment of exercise tolerance in adolescents shortly after sport-related concussion (SRC) and (2) the prognostic utility of such assessment. DESIGN: Prospective randomized controlled trial. SETTING:University and community sports medicine centers. PARTICIPANTS: Adolescents with SRC (1-9 days from injury). Sixty-five were randomized and 54 completed the study (mean age 15 years, 4 days after injury). INTERVENTIONS: Buffalo Concussion Treadmill Test (BCTT, n = 27) or not (controls, n = 27) on visit day #1. Heart rate threshold (HRt) at symptom exacerbation represented level of exercise tolerance. Participants reported symptoms daily for 14 days and then had follow-up BCTT (n = 54). Recovery was defined as returning to normal level of symptoms and exercise tolerance, verified by independent physician examination. MAIN OUTCOME MEASURES: Days to recovery and typical (≤21 days) versus prolonged recovery (>21 days). Mixed effects linear models and linear regression techniques examined symptom reports and time to recovery. Linear regression assessed the association of HRt with recovery time. RESULTS: Days to recovery (P = 0.7060) and typical versus prolonged recovery (P = 0.1195) were not significantly different between groups. Symptom severity scores decreased in both groups over 14 days (P < 0.0001), were similar (P = 0.2984), and did not significantly increase the day after the BCTT (P = 0.1960). Lower HRt on visit day #1 was strongly associated with prolonged recovery time (P = 0.0032). CONCLUSIONS: Systematic evaluation of exercise tolerance using the BCTT within 1 week after SRC did not affect recovery. The degree of early exercise intolerance after SRC was important for prognosis. This has implications for school academic and team preparation.
RCT Entities:
OBJECTIVE: To evaluate (1) systematic assessment of exercise tolerance in adolescents shortly after sport-related concussion (SRC) and (2) the prognostic utility of such assessment. DESIGN: Prospective randomized controlled trial. SETTING: University and community sports medicine centers. PARTICIPANTS: Adolescents with SRC (1-9 days from injury). Sixty-five were randomized and 54 completed the study (mean age 15 years, 4 days after injury). INTERVENTIONS: Buffalo Concussion Treadmill Test (BCTT, n = 27) or not (controls, n = 27) on visit day #1. Heart rate threshold (HRt) at symptom exacerbation represented level of exercise tolerance. Participants reported symptoms daily for 14 days and then had follow-up BCTT (n = 54). Recovery was defined as returning to normal level of symptoms and exercise tolerance, verified by independent physician examination. MAIN OUTCOME MEASURES: Days to recovery and typical (≤21 days) versus prolonged recovery (>21 days). Mixed effects linear models and linear regression techniques examined symptom reports and time to recovery. Linear regression assessed the association of HRt with recovery time. RESULTS: Days to recovery (P = 0.7060) and typical versus prolonged recovery (P = 0.1195) were not significantly different between groups. Symptom severity scores decreased in both groups over 14 days (P < 0.0001), were similar (P = 0.2984), and did not significantly increase the day after the BCTT (P = 0.1960). Lower HRt on visit day #1 was strongly associated with prolonged recovery time (P = 0.0032). CONCLUSIONS: Systematic evaluation of exercise tolerance using the BCTT within 1 week after SRC did not affect recovery. The degree of early exercise intolerance after SRC was important for prognosis. This has implications for school academic and team preparation.
Authors: Carol Dematteo; Kimberly A Volterman; Peter G Breithaupt; Everett A Claridge; John Adamich; Brian W Timmons Journal: Med Sci Sports Exerc Date: 2015-11 Impact factor: 5.411
Authors: Danny George Thomas; Jennifer N Apps; Raymond G Hoffmann; Michael McCrea; Thomas Hammeke Journal: Pediatrics Date: 2015-01-05 Impact factor: 7.124
Authors: John J Leddy; Jennifer L Cox; John G Baker; David S Wack; David R Pendergast; Robert Zivadinov; Barry Willer Journal: J Head Trauma Rehabil Date: 2013 Jul-Aug Impact factor: 2.710
Authors: Paul McCrory; Willem Meeuwisse; Mark Aubry; Bob Cantu; Jiri Dvorak; Ruben J Echemendia; Lars Engebretsen; Karen Johnston; Jeffrey S Kutcher; Martin Raftery; Allen Sills; Brian W Benson; Gavin A Davis; Richard G Ellenbogen; Kevin M Guskiewicz; Stanley A Herring; Grant Iverson; Barry D Jordan; James Kissick; Michael McCrea; Andrew S McIntosh; David L Maddocks; Michael Makdissi; Laura Purcell; Margot Putukian; Michael Turner; Kathryn Schneider; Charles H Tator Journal: Clin J Sport Med Date: 2013-03 Impact factor: 3.638
Authors: Kathryn J Schneider; Grant L Iverson; Carolyn A Emery; Paul McCrory; Stanley A Herring; Willem H Meeuwisse Journal: Br J Sports Med Date: 2013-04 Impact factor: 13.800
Authors: Corwin Boake; Stephen R McCauley; Harvey S Levin; Claudia Pedroza; Charles F Contant; James X Song; Sharon A Brown; Heather Goodman; Susan I Brundage; Pedro J Diaz-Marchan Journal: J Neuropsychiatry Clin Neurosci Date: 2005 Impact factor: 2.198
Authors: James D Carson; David W Lawrence; Sari A Kraft; Alisha Garel; Catherine L Snow; Ananda Chatterjee; Paula Libfeld; Heather M MacKenzie; Jane S Thornton; Rahim Moineddin; Pierre Frémont Journal: Can Fam Physician Date: 2014-06 Impact factor: 3.275
Authors: John J Leddy; Mohammad N Haider; Michael J Ellis; Rebekah Mannix; Scott R Darling; Michael S Freitas; Heidi N Suffoletto; Jeff Leiter; Dean M Cordingley; Barry Willer Journal: JAMA Pediatr Date: 2019-04-01 Impact factor: 16.193
Authors: Barry S Willer; Mohammad N Haider; Itai Bezherano; Charles G Wilber; Rebekah Mannix; Katherine Kozlowski; John J Leddy Journal: Arch Phys Med Rehabil Date: 2019-08-01 Impact factor: 3.966
Authors: Andrew R Mayer; Christopher Wertz; Sephira G Ryman; Eileen P Storey; Grace Park; John Phillips; Andrew B Dodd; Scott Oglesbee; Richard Campbell; Ronald A Yeo; Benjamin Wasserott; Nicholas A Shaff; John J Leddy; Rebekah Mannix; Kristy B Arbogast; Timothy B Meier; Matthew F Grady; Christina L Master Journal: J Neurotrauma Date: 2018-03-20 Impact factor: 5.269