Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomized Clinical Trial

Langevin, Pierre; Frémont, Pierre; Fait, Philippe; Dubé, Marc-Olivier; Bertrand-Charette, Michaël; Roy, Jean‐Sébastien

doi:10.1089/neu.2021.0508

Cited by 8 publications

(21 citation statements)

References 46 publications

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“…Chronic concussion . The evidence on multimodal rehabilitation for chronic concussion includes 10 studies: 3 RCTs, 69,106,107 1 prospective comparative study, 108 1 retrospective comparative study, 109 and 5 case series (3 prospective and 2 retrospective) 75,76,80,81,110 in adolescents and/or adults. No evidence was found on multimodal rehabilitation for children with chronic concussion.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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show abstract

“…A total of 44 articles received a full-text review for eligibility, of which 8 were included in the qualitative synthesis. [27][28][29][30][31][32][33][34] Only 6 articles met the criteria for meta-analysis, [28][29][30][31][32][33] while the remaining 2 studies were excluded to avoid heterogeneity due to their cohort design. 27,34 For the qualitative analysis, results from nonpooled studies were narratively described for each outcome to either support or contrast findings from the meta-analysis.…”

Section: Study Selectionmentioning

confidence: 99%

“…Three studies incorporated cervical/upper thoracic manual therapy including manipulation, mobilization, and soft tissue techniques along into the VR program. [31][32][33] The total duration of therapy program differed between studies. The duration of the intervention program varied from 4 weeks, 27,29,30,32 6 weeks, 31 to 8 weeks.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[31][32][33] The total duration of therapy program differed between studies. The duration of the intervention program varied from 4 weeks, 27,29,30,32 6 weeks, 31 to 8 weeks. 28,33,34 Only 2 studies followed patients after the end of treatment with a follow-up period ranging from 1 to 6 months.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…28,33,34 Only 2 studies followed patients after the end of treatment with a follow-up period ranging from 1 to 6 months. 28,31 Characteristics of included studies are summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis

Aljabri

Halawani

Ashqar

et al. 2024

Journal of Head Trauma Rehabilitation

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Objective: Mild traumatic brain injury (mTBI) or concussion is a common yet undermanaged and underreported condition. This systematic review and meta-analysis aim to determine the efficacy of vestibular rehabilitation therapy (VRT) as a treatment option for mTBI. Method: This review and meta-analysis was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. It included randomized controlled trials and pre-VRT/post-VRT retrospective chart reviews. Records meeting the inclusion criteria were extracted from the following databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Eight articles met the inclusion criteria, from which 6 randomized controlled trials were included in the meta-analysis. VRT demonstrated significant improvement in decreasing perceived dizziness at the end of the intervention program as shown by Dizziness Handicap Inventory (DHI) scores (standardized mean difference [SMD] = −0.33, 95% confidence interval [CI]: −0.62 to −0.03, P = .03, I 2 = 0%). However, no significant reduction in DHI was evident after 2 months of follow-up (SMD = 0.15, 95% CI: −0.23 to 0.52, P = .44, I 2 = 0%). Quantitative analysis also depicted significant reduction in both Vestibular/Ocular Motor Screening (SMD = −0.40, 95% CI: −0.60 to −0.20, P < .0001, I 2 = 0%) and Post-Concussion Symptom Scale (SMD= −0.39, 95% CI: −0.71 to −0.07, P = .02, I 2 = 0%) following the intervention. Finally, there was no significant difference between intervention groups on Balance Error Scoring System scores (SMD = −31, 95% CI: −0.71 to 0.10, P = .14, I 2 = 0%) and return to sport/function (95% CI: 0.32-30.80, P = .32, I 2 = 82%). Conclusions: Current evidence on the efficacy of VRT for mTBI is limited. This review and analysis provides evidence that supports the role of VRT in improving perceived symptoms following concussion. Although findings from this analysis suggest positive effects of VRT on included outcomes, the low certainty of evidence limits the conclusions drawn from this study. There is still a need for high-quality trials evaluating the benefit of VRT using a standardized approach. PROSPERO registration number: CRD42022342473.

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How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

van Ierssel,

Galea,

Holte

et al. 2024

Journal of Sport and Health Science

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Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomized Clinical Trial

Cited by 8 publications

References 46 publications

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

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

The Efficacy of Vestibular Rehabilitation Therapy for Mild Traumatic Brain Injury: A Systematic Review and Meta-analysis

How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

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