Details

Autor(en) / Beteiligte

• Register-Mihalik, Johna
• Guskiewicz, Kevin
• Marshall, Stephen
• McCulloch, Karen
• Mihalik, Jason
• Mrazik, Martin
• Murphy, Ian
• Naidu, Dhiren
• Ranapurwala, Shabbar
• Schneider, Kathryn
• Salmon, Danielle
• Gildner, Paula
• Kostogiannes, Vasiliki
• McCrea, Michael

Titel

5.8 Effectiveness of early multi-dimensional rehabilitation following sport-related concussion: a randomized trial

Ist Teil von

• British journal of sports medicine, 2024-01, Vol.58 (Suppl 1), p.A104-A104

Ort / Verlag

London: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine

Erscheinungsjahr

2024

Quelle

BMJ journals single titles

Beschreibungen/Notizen

• ObjectiveEvaluate effectiveness of early-stage multi-dimensional rehabilitation (MDR) on return to sport (RTS).DesignTwo-arm randomized unblinded trial (NCT02988596).SettingProfessional, collegiate, and interscholastic sports (28 sites in USA, Canada, and New Zealand).ParticipantsConsented participants with provider-diagnosed concussion (n=251; 52 professional-Canadian football, 31 professional rugby, 128 college/university, 40 interscholastic; 20% female), randomized by site.Interventions (or Assessment of Risk Factors)An early-MDR arm (n=132) included cognitive, visual-vestibular, symptom comfort, and balance activities; after the athlete was asymptomatic, MDR activities were integrated with standardized sport-specific Enhanced Graded Exertion (EGE) strategies. The comparator EGE arm (n=119) used only conventional exertion strategies (i.e. no early-stage MDR). Prescribed MDR-arm activities started after symptoms stabilized (i.e. pre-asymptomatic). Prescribed EGE activities started once deemed clinically asymptomatic (within 85% of pre-injury baseline). Both arm-specific protocols were initiated at first visit post-injury and continued to RTS clearance.Outcome MeasuresMultistage survival models analyzed complete days from injury until asymptomatic, and complete days post-asymptomatic to full medical clearance for RTS.Main ResultsTime to asymptomatic did not differ between arms (p=0.8612). Thereafter (i.e. post-asymptomatic), MDR athletes more rapidly progressed to RTS clearance (p<0.0001). MDR athletes (median 13 days; 95%CI: 13, 16) therefore achieved RTS clearance following concussion quicker (p=0.0190) than EGE-only athletes (median 19 days; 95%CI: 15, 22). By 14 days post-injury, 54.6% of MDR-arm athletes were cleared for RTS, compared to versus 37.8% of EGE-only athletes (p=0.0019).ConclusionsNotwithstanding similar initial symptom recovery times, MDR athletes progressed through the post-asymptomatic RTS strategy significantly faster than EGE athletes.