Stephen Kara1, Hannah Crosswell1, Katherine Forch1, Alana Cavadino2, Josh McGeown3, Mark Fulcher1. 1. Axis Sports Medicine Specialists, Auckland, New Zealand. 2. Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand; and. 3. Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
Abstract
OBJECTIVE: To describe clinical recovery time and factors that might impact on recovery after a sports-related mild traumatic brain injury (SR-mTBI; concussion). DESIGN: Prospective cohort study (level IV evidence). SETTING: New Zealand Sports Concussion Clinic. PARTICIPANTS: Eight hundred twenty-two patients presenting within 14 days of a SR-mTBI/concussion over a 2-year period. MAIN OUTCOME MEASURES: Clinical recovery measured as number of days after injury. INTERVENTIONS METHODS: Participants were assessed and managed using a standardized protocol consisting of relative rest followed by controlled cognitive and physical loading. A reassessment was performed 14 days after injury with initiation of an active rehabilitation program consisting of a subsymptom threshold exercise program ± cervicovestibular rehabilitation (if required) for participants who remained symptomatic. Participants were then assessed every 2 weeks until clinical recovery. RESULTS: A total of 594 participants were eligible for analysis (mean age 20.2 ± 8.7 years, 77% males) and were grouped into 3 age cohorts: children (≤12 years), adolescents (13-18 years), and adults (≥19 years). Forty-five percent of participants showed clinical recovery within 14 days of injury, 77% by 4 weeks after injury, and 96% by 8 weeks after injury. There was no significant difference in recovery time between age groups. Prolonged recovery was more common in females (P = 0.001), participants with "concussion modifiers" (P = 0.001), and with increased time between injury and the initial appointment (P = 0.003). CONCLUSIONS: This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate. Active rehabilitation results in high recovery rates after SR-mTBI.
OBJECTIVE: To describe clinical recovery time and factors that might impact on recovery after a sports-related mild traumatic brain injury (SR-mTBI; concussion). DESIGN: Prospective cohort study (level IV evidence). SETTING: New Zealand Sports Concussion Clinic. PARTICIPANTS: Eight hundred twenty-two patients presenting within 14 days of a SR-mTBI/concussion over a 2-year period. MAIN OUTCOME MEASURES: Clinical recovery measured as number of days after injury. INTERVENTIONS METHODS:Participants were assessed and managed using a standardized protocol consisting of relative rest followed by controlled cognitive and physical loading. A reassessment was performed 14 days after injury with initiation of an active rehabilitation program consisting of a subsymptom threshold exercise program ± cervicovestibular rehabilitation (if required) for participants who remained symptomatic. Participants were then assessed every 2 weeks until clinical recovery. RESULTS: A total of 594 participants were eligible for analysis (mean age 20.2 ± 8.7 years, 77% males) and were grouped into 3 age cohorts: children (≤12 years), adolescents (13-18 years), and adults (≥19 years). Forty-five percent of participants showed clinical recovery within 14 days of injury, 77% by 4 weeks after injury, and 96% by 8 weeks after injury. There was no significant difference in recovery time between age groups. Prolonged recovery was more common in females (P = 0.001), participants with "concussion modifiers" (P = 0.001), and with increased time between injury and the initial appointment (P = 0.003). CONCLUSIONS: This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate. Active rehabilitation results in high recovery rates after SR-mTBI.
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