Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review

Kathryn J Schneider; Meghan L Critchley; Vicki Anderson; Gavin A Davis; Chantel T Debert; Nina Feddermann-Demont; Isabelle Gagnon; Kevin M Guskiewicz; K Alix Hayden; Stanley Herring; Corson Johnstone; Michael Makdissi; Christina L Master; Rosemarie Scolaro Moser; Jon S Patricios; Johna K Register-Mihalik; Paul E Ronksley; Noah D Silverberg; Keith Owen Yeates

doi:10.1136/bjsports-2022-106685

Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review

Br J Sports Med. 2023 Jun;57(12):771-779. doi: 10.1136/bjsports-2022-106685.

Authors

Kathryn J Schneider^{1

2

3}, Meghan L Critchley⁴, Vicki Anderson^{5

6}, Gavin A Davis^{7

8}, Chantel T Debert⁹, Nina Feddermann-Demont¹⁰, Isabelle Gagnon¹¹, Kevin M Guskiewicz¹², K Alix Hayden¹³, Stanley Herring¹⁴, Corson Johnstone⁴, Michael Makdissi^{15

16}, Christina L Master¹⁷, Rosemarie Scolaro Moser¹⁸, Jon S Patricios¹⁹, Johna K Register-Mihalik²⁰, Paul E Ronksley²¹, Noah D Silverberg²², Keith Owen Yeates^{2

3

23}

Affiliations

¹ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada [email protected].
² Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
³ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
⁴ University of Calgary, Calgary, Alberta, Canada.
⁵ Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
⁶ Psychology, University of Melbourne, Parkville, Victoria, Australia.
⁷ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁸ Cabrini Health, Malvern, Victoria, Australia.
⁹ Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Neurology, University Hospital Zurich, Zurich Switzerland Sports Neuroscience, University of Zurich, Zurich, Switzerland.
¹¹ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
¹² Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹³ Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada.
¹⁴ Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA.
¹⁵ Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia.
¹⁶ Australian Football League, Melbourne, Victoria, Australia.
¹⁷ Pediatrics and Sports Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁸ Sports Concussion Center of New Jersey, Princeton, New Jersey, USA.
¹⁹ Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁰ Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
²¹ Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
²² Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.
²³ Psychology, University of Calgary, Calgary, Alberta, Canada.

PMID: 37316188
DOI: 10.1136/bjsports-2022-106685

Abstract

Objectives: We evaluated interventions to facilitate recovery in children, adolescents and adults with a sport-related concussion (SRC).

Design: Systematic review including risk of bias (modified Scottish Intercollegiate Guidelines Network tool).

Data sources: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus with Full Text, SPORTDiscus and Scopus searched until March 2022.

Study eligibility criteria: (1) Original research including randomised controlled trials (RCTs), quasi-experimental designs, cohort, comparative effectiveness studies; (2) focus on SRC; (3) English; (4) peer-reviewed and (5) evaluated treatment.

Results: 6533 studies were screened, 154 full texts reviewed and 13 met inclusion (10 RCTs, 1 quasi-experimental and 2 cohort studies; 1 high-quality study, 7 acceptable and 5 at high risk of bias). Interventions, comparisons, timing and outcomes varied, precluding meta-analysis. For adolescents and adults with dizziness, neck pain and/or headaches >10 days following concussion, individualised cervicovestibular rehabilitation may decrease time to return to sport compared with rest followed by gradual exertion (HR 3.91 (95% CI 1.34 to 11.34)) and when compared with a subtherapeutic intervention (HR 2.91 (95% CI 1.01 to 8.43)). For adolescents with vestibular symptoms/impairments, vestibular rehabilitation may decrease time to medical clearance (vestibular rehab group 50.2 days (95% CI 39.9 to 60.4) compared with control 58.4 (95% CI 41.7 to 75.3) days). For adolescents with persisting symptoms >30 days, active rehabilitation and collaborative care may decrease symptoms.

Conclusions: Cervicovestibular rehabilitation is recommended for adolescents and adults with dizziness, neck pain and/or headaches for >10 days. Vestibular rehabilitation (for adolescents with dizziness/vestibular impairments >5 days) and active rehabilitation and/or collaborative care (for adolescents with persisting symptoms >30 days) may be of benefit.

Keywords: Brain Concussion; Recovery; Rehabilitation; Sport.

Publication types

Systematic Review

MeSH terms

Adolescent
Adult
Brain Concussion* / therapy
Child
Dizziness
Headache
Humans
Medicine*
Neck Pain