Do physical interventions improve outcomes following concussion : A systematic review and meta-analysis?

Journal article

Reid, Susan A., Farbenblum, Joshua and McLeod, Shreya. (2022). Do physical interventions improve outcomes following concussion : A systematic review and meta-analysis? British Journal of Sports Medicine. 56(5), pp. 292-298. https://doi.org/10.1136/bjsports-2020-103470
AuthorsReid, Susan A., Farbenblum, Joshua and McLeod, Shreya
Abstract

Objective To investigate the effect of physical interventions (subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies) on days to recovery and symptom scores in the management of concussion.

Design A systematic review and meta-analysis.

Data sources Medline, CINAHL, Embase, SportDiscus, Cochrane library, Scopus and PEDro.

Eligibility criteria Randomised controlled trials of participants with concussion that evaluated the effect of subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies on days to recovery/return to activity, symptom scores, balance, gait and/or exercise capacity.

Results Twelve trials met the inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions. The trials were of fair to excellent quality on the PEDro scale. Eight trials were included in the quantitative analysis. Subthreshold aerobic exercise had a significant small to moderate effect in improving symptom scores (standardised mean difference (SMD)=0.43, 95% CI 0.18 to 0.67, p=0.001, I2=0%) but not in reducing days to symptom recovery in both acutely concussed individuals and those with persistent symptoms (SMD=0.19, 95% CI −0.54 to 0.93, p=0.61, I2=52%). There was limited evidence for stand-alone cervical, vestibular and oculomotor therapies. Concussed individuals with persistent symptoms (>2 weeks) were approximately 3 times more likely to have returned to sport by 8 weeks (relative risk=3.29, 95% CI 0.30 to 35.69, p=0.33, I2=83%) if they received individually tailored, presentation-specific multimodal interventions (cervical, vestibular and oculo-motor therapy). In addition, the multimodal interventions had a moderate effect in improving symptom scores (SMD=0.63, 95% CI 0.11 to 1.15, p=0.02, I2=0%) when compared with control.

Conclusions Subthreshold aerobic exercise appears to lower symptom scores but not time to recovery in concussed individuals. Individually tailored multimodal interventions have a worthwhile effect in providing faster return to sport and clinical improvement, specifically in those with persistent symptoms.

PROSPERO registration number CRD42020108117.

Year2022
JournalBritish Journal of Sports Medicine
Journal citation56 (5), pp. 292-298
PublisherBMJ Publishing Group
ISSN0306-3674
Digital Object Identifier (DOI)https://doi.org/10.1136/bjsports-2020-103470
PubMed ID34593371
Scopus EID2-s2.0-85124850419
Open accessOpen access
Page range292-298
Publisher's version
License
All rights reserved
File Access Level
Open
Output statusPublished
Publication dates
Online30 Sep 2021
Publication process dates
Accepted21 Sep 2021
Deposited26 Jul 2023
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