Do physical interventions improve outcomes following concussion : A systematic review and meta-analysis?
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
|Authors||Reid, Susan A., Farbenblum, Joshua and McLeod, Shreya|
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.
|Journal||British Journal of Sports Medicine|
|Journal citation||56 (5), pp. 292-298|
|Publisher||BMJ Publishing Group|
|Digital Object Identifier (DOI)||https://doi.org/10.1136/bjsports-2020-103470|
|Open access||Open access|
All rights reserved
File Access Level
|Online||30 Sep 2021|
|Publication process dates|
|Accepted||21 Sep 2021|
|Deposited||26 Jul 2023|
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