JMIR Publications

ABSTRACT

Background:

Our research team developed evidence-based Return to Activity and Return to School protocols for youths with concussion which are based on the Sports Concussion Consensus statements and the main management strategy for concussion recovery.

Objective:

It is important to determine if youth with concussion adhere to these protocols before evaluation in randomized control trials. Youth who were more adherent would have a lower incidence of repeat injury, shorter times to Return to Activity and better outcomes in quality of life, mental health, and cognition measures.

Methods:

Participants were recruited from the Hospital Emergency Department, community referrals from their primary physician, and rehabilitation or sports medicine clinics. Youths (N=139) aged 5-18 with concussion. In this prospective longitudinal cohort study, self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution. Daily accelerometry data was collected. Participants were evaluated using a battery of measures at 3 time points. Participants were not blinded or randomized.

Results:

   For Return to Activity Stage 1, 13% of participants were adherent. 11% and 34% of participants were adherent for Stage 2 and 3, respectively. The median time to symptom-resolution for participants who self-reported adherence to the Return to Activity protocol was 13 days and 20 days for those who self-reported non-adherence (p=0.03). The re-injury rate among the cohort was 2% (N=3).  

Conclusions:

  Adherence to staged protocols post-concussion was minimal when assessed with accelerometers, but higher by self-report. More physical activity restrictions resulted in lower adherence. Although adherence was low, re-injury rate was low suggesting a protective effect of monitoring and Return to Activity protocols. The results of this study support an ease in protocols and earlier resumption of activities.