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Safety of Active Rehabilitation for Persistent Symptoms After Pediatric Sport-Related Concussion: A Randomized Controlled Trial

  • Catherine Chan
    Affiliations
    GF Strong Rehab Centre, Vancouver, British Columbia, Canada

    Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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  • Grant L. Iverson
    Affiliations
    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
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  • Jacqueline Purtzki
    Affiliations
    GF Strong Rehab Centre, Vancouver, British Columbia, Canada

    Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
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  • Kathy Wong
    Affiliations
    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
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  • Vivian Kwan
    Affiliations
    University of Calgary, Calgary, Alberta, Canada
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  • Isabelle Gagnon
    Affiliations
    McGill University, Montreal, Quebec, Canada

    Montreal Children's Hospital, Montreal, Quebec, Canada
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  • Noah D. Silverberg
    Correspondence
    Corresponding author Noah D. Silverberg, PhD, Rehabilitation Research Program, 4255 Laurel St, Vancouver, BC V5Z 2G9, Canada.
    Affiliations
    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
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Published:October 06, 2017DOI:https://doi.org/10.1016/j.apmr.2017.09.108

      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)
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