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.
Keywords
List of abbreviations:
PCSS (Post-Concussion Symptom Scale), TAU (Treatment as usual)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 06, 2017
Footnotes
Supported by a Team Grant Award from the Vancouver Coastal Health Research Institute.
Clinical Trial Registration No.: NCT02031068.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
