JMIR Publications

ABSTRACT

Background:

Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children 1-17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population.

Objective:

This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of re-injury.

Methods:

Children and youth (N=139) aged 5-18 with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph®. Data was collected to evaluate adherence to the RTA protocol based on physical activity cut-off points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive and behavioural measures, at recruitment, symptom-resolution and 3-months post symptom resolution.

Results:

For RTA Stage 1, 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for Stage 2 and 3, respectively. The median time to symptom resolution for participants who were subjectively reported adherent to the RTA protocol was 13 days and 20 days for those who subjectively were reported as (p=0.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol, as well as to other clinical outcomes such as depression, quality of life and balance. The rate of re-injury among the entire cohort was 2% (N=3).

Conclusions:

Overall, adherence to staged protocols post-concussion was minimal when assessed with accelerometers, but higher by self-report. More physical activity restrictions as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, re-injury rate was lower than would be expected, suggesting a protective effect of being monitored and youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols. Clinical Trial: Canadian Institutes of Health Research (CIHR) grant number: 31257 to C.D.