Early aerobic exercise among adolescents at moderate/high risk for persistent post-concussion symptoms: A pilot randomized clinical trial

Howell, David R.; Wingerson, Mathew J.; Kirkwood, Michael W.; Grubenhoff, Joseph A.; Wilson, Julie C.

doi:10.1016/j.ptsp.2022.04.010

Cited by 16 publications

(28 citation statements)

References 36 publications

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“…Although it is not recommended to complete 100 minutes of exercise in a single bout, others have shown that adolescents after SRC benefit from an exercise volume well above 100 minutes per week. 20 Provided that patients stay below their symptom-exacerbation HR threshold (ie, intensity), they can exercise well beyond their prescribed duration (volume) with no ill effects. 19 Regular modification of the exercise prescription will improve effectiveness and adherence.…”

Section: Intensity Of the Exercise Prescriptionmentioning

confidence: 99%

Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing

Chizuk

Haider

Edmonds

et al. 2022

Clinical Journal of Sport Medicine

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Section: Intensity Of the Exercise Prescriptionmentioning

confidence: 99%

Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing

Chizuk

Haider

Edmonds

et al. 2022

Clinical Journal of Sport Medicine

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“…Prior work has emphasized the importance of timely care after a concussion in providing an accurate diagnosis, initiating treatment early in recovery, and contributing to improved patient outcomes. 2,3,7,8,12,[15][16][17]24 Our study identified a number of areas that may affect time from the injury to a specialty evaluation and subsequently patient outcomes. Specifically, the division of time to the specialty evaluation into 2 sequential time frames, that is, time from the injury to scheduling and time from scheduling to the specialty evaluation, allows for a preliminary understanding of how patient and injury factors specifically influence the process of accessing care after an injury.…”

Section: Discussionmentioning

confidence: 99%

Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care

Wingerson,

Magliato,

Smulligan

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: The timing of clinical evaluation after pediatric concussion represents an important and potentially modifiable clinical milestone for diagnosis, selection of appropriate treatment pathways, and recovery prognosis. Patient demographics, socioeconomic status, or medical history may affect the time to the initial evaluation and subsequently influence recovery outcomes. Purpose/Hypothesis: The purpose of this investigation was to evaluate the association of patient characteristics with the time to specialty evaluation after a concussion. It was hypothesized that patients with a history of concussion, a preexisting relationship with our specialty concussion program, or a higher ZIP code–based income estimate would present for care more quickly after a concussion than patients without these characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were patients with a concussion between 6 and 18 years old who were seen for care at a single sports medicine center between January 1 and December 31, 2019. Patient demographic, socioeconomic, injury, and clinical characteristics were collected through a retrospective review of the medical records. The primary outcome was the number of days between the date of the concussion and the patient’s initial specialty evaluation. Results: Overall, 220 patients (mean age, 14.4 ± 2.5 years; 46% female) were seen for care at a mean of 9.7 ± 5.6 days (range, 1-21 days) after concussion. A shorter time to specialty evaluation was associated with a history of concussion (β = –1.72 [95% CI, –3.24 to –0.20]; P = .03) and a prior clinical relationship with the treating clinical department (β = –1.85 [95% CI, –3.52 to –0.19]; P = .03). Referral by a primary care provider was associated with a longer time to evaluation (β = 3.86 [95% CI, 2.39-5.33]; P < .0001). Conclusion: A history of concussion and having a preexisting clinical relationship with the deparment were associated with a shorter time to evaluation after concussion. Referral from a primary care physician was associated with a longer time to evaluation. Issues may exist in the propensity to access care after an injury, resulting in delays for initiating early treatment.

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“…Although every effort was made to instruct patients to complete HEPs as prescribed, as is the case with any at-home treatment program, it is not known how often and to what extent each patient completed their rehabilitation, limiting our ability to draw conclusions about a dose-response relationship. Additionally, although both groups were provided the same recommendations regarding aerobic physical exercise, it is possible that the HEP treatment group engaged in more physical activity than the PPT patients, which could have contributed to faster recovery [ 41 , 42 ]. Finally, generalizability is limited by a relatively homogenous sample related to race and ethnicity and due to the analytic sample receiving care within a specialty concussion clinic in a major metropolitan area with onsite access to PT and healthcare professionals trained in the management of SRC.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prescribed Physical Therapy to a Home Exercise Program for Pediatric Sports-Related Concussion Patients

et al. 2022

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The purpose of this retrospective chart review was to compare sports-related concussion (SRC) recovery time in protracted recovery (≥28 days) patients who were prescribed physical therapy (PPT) with those who were only provided a home exercise program (HEP). We hypothesized PPT would be associated with shorter recovery times relative to HEP. Associations were evaluated with multivariable zero-truncated negative binomial regressions. Among the 48 (30.2%) PPT and 111 (69.8%) HEP patients, the majority were female (57.9%), the mean age was 15.3 ± 1.4 (PPT) and 14.2 ± 2.8 (HEP), and time to clinic was a median 6.0 (IQR = 3.0–27.0; PPT) and 7.0 (IQR = 3.0–23.0; HEP) days. After adjusting for demographic (age, sex) and clinical measures (concussion history, convergence, VOMS, PCSS score, and days to clinic), PPT unexpectedly was associated with 1.21 (95% CI: 1.05, 1.41) additional recovery days compared with HEP. One reason for this could be related to patients adhering to the number of a priori prescribed PT sessions which may or may not have aligned with the patient’s symptom resolution. Future research should explore this hypothesis while aiming to evaluate the effect of PPT versus HEP using a randomized design. If confirmed, these findings are encouraging for patient who could not otherwise access or afford specialty rehabilitation."

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Early aerobic exercise among adolescents at moderate/high risk for persistent post-concussion symptoms: A pilot randomized clinical trial

Cited by 16 publications

References 36 publications

Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing

Practical Management: A Standardized Aerobic Exercise Program for Adolescents With Concussion in the Absence of Graded Exercise Testing

Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care

Comparison of Prescribed Physical Therapy to a Home Exercise Program for Pediatric Sports-Related Concussion Patients

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