Activity Level During Acute Concussion May Predict Symptom Recovery Within an Active Duty Military Population

Remigio-Baker, Rosemay A.; Bailie, Jason M.; Gregory, Emma; Cole, Wesley R.; McCulloch, Karen; Cecchini, Amy; Stuessi, Keith; Andrews, Taylor R.; Mullins, Lynita; Ettenhofer, Mark L.

doi:10.1097/htr.0000000000000498

Cited by 9 publications

(28 citation statements)

References 38 publications

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“…Optimal patterns of activity during the course of concussion recovery may depend on the severity of symptoms experienced in the acute stage. In a recent study by our group, greater activity level at acute stages of concussion was associated with higher levels of symptoms over time, but only among those with high levels of acute symptoms (9). In the current study, we build upon our previous findings by evaluating the contribution of activities at later stages of concussion rehabilitation post-concussion.…”

Section: Introductionmentioning

confidence: 90%

“…A growing body of evidence has shown the importance of monitoring and regulating activity level in the first hours to days following a concussion (2–8); however, little attention has been given to the contribution of post-acute (i.e., ≥1 month[s]) activity level on symptom recovery in the weeks and months that follow. Furthermore, most of these studies have focused on sports-related concussion (2–5, 7, 8), while only a limited number provide information about active duty military personnel (9), who may have a greater risk for concussion, and among whom the consequences of persistent impairments impact military force readiness. Research has also been sparse in the evaluation of symptom recovery against activity by specific categories (e.g., cognitive, physical, vestibular/balance).…”

Section: Introductionmentioning

confidence: 99%

“…A similar set of guidelines, the Progressive Return to Activity (PRA) Clinical Recommendation (CR), which emphasize gradual return to activity after rest at the acute stage of concussion, was developed specifically for SMs by military and civilian subject-matter experts and published by the Defense and Veterans Brain Injury Center (DVBIC) (1). Recent research among SMs suggests that activity participation within the acute stage of injury impacts symptom resolution over time (9); however, it is unknown how post-acute levels of activities, particularly the type of activities conducted to include military-specific tasks (e.g., combat training), may influence continued improvement in symptomatology.…”

Section: Introductionmentioning

confidence: 99%

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Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population

et al. 2019

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Background: Previous research demonstrates that early rest and gradual increases in activity after concussion can improve symptoms; however, little is known about the intensity and type of activity during post-acute time periods—specifically months post-injury—that may promote optimal recovery in an active duty service member (SM) population. Objective: The objectives of this study were to investigate how activity level and type at the post-acute stages of concussion (at 1 and 3 month[s] post-injury) impact subsequent symptoms among SMs, and how this relationship might differ by the level of symptoms at the time of injury. Methods: Participants included 39 SMs ages 19–44 years from 3 military installations who were enrolled within 72 h after sustaining a concussion. Linear regression was used to evaluate whether the association between activity level at 1 or 3 month(s) post-injury (as measured by a multi-domain Activity Questionnaire) and subsequent symptoms at 3 and/or 6 months (as measured by the Neurobehavioral Symptom Inventory) varied by the level of symptoms at acute stages of concussion. Partial correlation was used to evaluate relationships that did not differ by acute symptom level. Symptoms at the time of activity assessment (1 or 3 month[s]) were accounted for in all models, as well as activity level at acute stages of concussion. Results: Greater physical and vestibular/balance activity at 1 month were significantly correlated with lower symptoms at 3 months, but not at 6 months post-injury. There were no significant associations found between activity (total or by type) at 3 months and symptoms at 6 months. The association between activity level at either 1 or 3 months and subsequent symptoms at 3 and/or 6 months did not differ by the level of acute symptoms. Conclusion: The intensity and type of activities in which SMs engage at post-acute stages of concussion may impact symptom recovery. Although low levels of activity have been previously shown to be beneficial during the acute stage of injury, higher levels of activity may provide benefit at later stages. These findings provide support for the importance of monitoring and managing activity level beyond the acute stage of concussion.

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population

et al. 2019

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“…Interestingly, the negative effects of excessive activity were most prominent for vestibular symptoms, such as dizziness or loss of balance. 26 Results also suggested that patients who did not believe in the importance of rest after concussion experienced slower resolution of symptoms. 32 However, providers who over-emphasize rest-and those who fail to track their concussed patients beyond the initial phase of injury-may also overlook critical opportunities to optimize recovery, as excessive rest during post-acute stages of concussion has been shown to prolong symptoms.…”

Section: Changes In Neurobehavioral Symptoms and Activity Levels Acromentioning

confidence: 95%

“…25 As shown in Figure 1, concussed SMs in the DVBIC PRA study engaged in relatively low levels of activity (and high levels of rest) immediately after injury, followed by gradual increases in activity over the following 3 to 6 months, with an average increase in total activity of 63% over the full study time frame. 26,27 Physical, vestibular/balance, and military-specific activities increased most rapidly, whereas cognitive and lifestyle activities (i.e., reading, socializing, watching television) increased more slowly (Fig. 2).…”

Section: Changes In Neurobehavioral Symptoms and Activity Levels Acromentioning

confidence: 99%

Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members

Ettenhofer

Remigio-Baker

Bailie

et al. 2020

Neurotrauma Reports

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Primary care providers can play a crucial role in the clinical management of concussion. However, many providers lack up-to-date information about best practices for rest and return to activity after these injuries. Most research on this topic has been conducted in athletes, and so less is known about how to assist patients with returning to activity in other settings and populations. This article provides a review of best practices for management of progressive return to activity after concussion, with an emphasis on ''lessons learned'' from the Defense and Veterans Brain Injury Center (DVBIC) Progressive Return to Activity (PRA) study, a multi-site longitudinal research project conducted to evaluate concussion management practices and the effectiveness of provider training on DVBIC clinical recommendations (CRs). Provider clinical practices and patient outcomes were examined at three U.S. military treatment facilities before and after providers completed a standardized training on DVBIC PRA CRs. In summary, research findings provide additional support that concussion recovery can be influenced by patients' activity levels after injury. Patients with concussion may experience poorer outcomes if they return to pre-injury levels of activity too rapidly, but they may also be at risk for prolonged symptoms if they fail to increase activity levels over time after an initial period of rest. Additionally, training primary care providers in return to activity guidelines can result in more effective patient education and better clinical outcomes. This knowledge can be used to inform best practices for progressive return to activity in both civilian and military settings.

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Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

De Luigi,

Bell,

Bramhall

et al. 2023

PM&R

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ObjectiveEarly diagnosis and appropriate management of concussion/mild traumatic brain injury (mTBI) is critical for preventing poor outcomes and minimizing healthcare burden. Current clinical guidelines for concussion management focus mostly on diagnosis and return to cognitive and physical activity but provide limited guidance on the use of specific therapeutic interventions.ObjectiveTo systematically review the available evidence on therapeutic interventions for concussion/mTBI and develop an evidence‐based consensus statement on the use of these interventions in clinical practice.Literature SurveyA systematic literature search was performed first in 2018 and 2019, and again in 2022, to identify relevant original research on these interventions. A total of 6303 articles were retrieved through the systematic literature search and screened for inclusion. Eighty articles met inclusion criteria and were included in this review and consensus process.MethodologyA multispecialty panel was convened to explore management of concussion/mTBI. Interventions evaluated included rest, exercise, rehabilitation, and return to activity (RTA) protocols. Studies were assessed for relevance and methodologic quality and were voted upon to develop an evidence‐based consensus statement on the therapeutic appropriateness of these interventions for concussion/mTBI. A meta‐analysis was not performed.SynthesisThere was sufficient evidence to recommend exercise as an appropriate therapy for adolescents with acute concussion/mTBI. In other age groups and for other therapeutic modalities, while some studies demonstrated benefits for some of the interventions, mixed results and study limitations prevented the panel from drawing firm conclusions on the efficacy of those interventions. The panel found evidence of detrimental effects from strict rest and high‐intensity physical activity.ConclusionsThe panel recommended exercise as an appropriate therapy for acute concussion in adolescents. The evidence on other therapeutic interventions for concussion/mTBI remains limited to small randomized controlled trials and observational studies of moderate to low quality. The panel found no strong evidence to support or recommend against the other evaluated interventions but found most interventions to be safe when used judiciously and in consideration of individual patient needs. High‐quality randomized studies with sufficient power are needed to evaluate the effects of rest, rehabilitation, and RTA protocols for the management of concussion/mTBI.This article is protected by copyright. All rights reserved.

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Activity Level During Acute Concussion May Predict Symptom Recovery Within an Active Duty Military Population

Cited by 9 publications

References 38 publications

Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population

Activity Level and Type During Post-acute Stages of Concussion May Play an Important Role in Improving Symptoms Among an Active Duty Military Population

Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

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