Rest and treatment/rehabilitation following sport-related concussion

Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Feddermann-Demont N, Iverson GL, Hayden A, Makdissi M. Rest and treatment/rehabilitation following
sport-related concussion: a systematic review. Br J Sports Med. 2017 Mar 24. pii: bjsports-2016-097475. doi:10.1136/bjsports-2016-097475. [Epub ahead of print]  

Abstract

AIM OR OBJECTIVE:

The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

DESIGN:

Systematic review.

DATA SOURCES:

MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded.

RESULTS:

Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care.

SUMMARY/CONCLUSIONS:

A brief period (24-48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO 2016:CRD42016039570.

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The focus of this paper was on the assessment of proof regarding rest and active treatment/rehabilitation, after sport–related concussion (SRC). The findings were suggestive of 24–48 hours of duration of cognitive and physical rest, being sufficient in a majority of the cases. After this, there was a requirement for encouragement to gradually increase activity. Interventions such as cervical and vestibular rehabilitation and multifaceted collaborative care were recommended. It also displayed the advantages of closely monitored sub–symptom threshold and submaximal exercise.

Methods

A systematic review was performed during this trial.

The findings were pooled from MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest Dissertations and Theses Global (Proquest).

The inclusion critera was set as: (1) original research; (2) reported SRC as the diagnosis; and (3) assessment of the effect of rest or active treatment/rehabilitation.

Exclusion criteria was: Review articles.

Results

28 studies met the inclusion criteria (9 in terms of the effects of rest and 19 analyzing active treatment).

The methodological quality of the literature appeared to be limited.

5 randomised controlled trials (RCTs) met the eligibility criteria.

There was inclusion of rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care.

Courtesy of:  https://www.mdlinx.com/neurology/medical-news-article/2017/04/07/rest-treatment-rehabilitation-sport-related-concussion/7108659/?category=latest&page_id=3