Research Reports - Rest and treatment/rehabilitation following sport-related concussion

Br J Sports Med. 2017 Mar 24. pii: bjsports-2016-097475. doi:
10.1136/bjsports-2016-097475. [Epub ahead of print]

Schneider KJ(1), Leddy JJ(2), Guskiewicz KM(3), Seifert T(4), McCrea M(5),
Silverberg ND(6), Feddermann-Demont N(7,)(8), Iverson GL(9), Hayden A(10),
Makdissi M(11,)(12).

AIM OR OBJECTIVE: The objective of this systematic review was to evaluate the
evidence regarding rest and active treatment/rehabilitation following
sport-related concussion (SRC).
DESIGN: Systematic review.
DATA SOURCES: MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane
Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE
(OVID) and Proquest DissertationsandTheses Global (Proquest) were searched
systematically.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they met the
following criteria: (1) original research; (2) reported SRC as the diagnosis; and
(3) evaluated the effect of rest or active treatment/rehabilitation. Review
articles were excluded.
RESULTS: Twenty-eight studies met the inclusion criteria (9 regarding the effects
of rest and 19 evaluating active treatment). The methodological quality of the
literature was limited; only five randomised controlled trials (RCTs) met the
eligibility criteria. Those RCTs included rest, cervical and vestibular
rehabilitation, subsymptom threshold aerobic exercise and multifaceted
collaborative care.
SUMMARY/CONCLUSIONS: A brief period (24-48 hours) of cognitive and physical rest
is appropriate for most patients. Following this, patients should be encouraged
to gradually increase activity. The exact amount and duration of rest are not yet
well defined and require further investigation. The data support interventions
including cervical and vestibular rehabilitation and multifaceted collaborative
care. Closely monitored subsymptom threshold, submaximal exercise may be of
benefit. 

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