Physical Activity and Intermittent Postconcussion Symptoms After a Period of Symptom-Limited Physical and Cognitive Rest

Quinton Sawyer; Brian Vesci; Tamara C. Valovich McLeod

摘要

Reference: Schneider KJ, Iverson GL, Emery CA, McCrory P, Herring SA, Meeuwisse WH. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304–307. Clinical Question: After concussion and a period of symptom-limited physical and cognitive rest, do athletes who experience intermittent symptoms return to asymptomatic condition more quickly with physical activity than with prolonged physical rest? Data Sources: One investigator performed an individual search for each research question using the following databases: CINAHL, Cochrane Controlled Trials Registers, EMBASE, HealthSTAR, ProQuest, PsychInfo, PubMed, SPORTDiscus, and Web of Science. Search terms for rest were brain concussion, cognitive rest, mild traumatic brain injury, physical exertion, postconcussive syndrome, rehabilitation, sport-related concussion, therapy, treatment, and treatment outcome. Search terms for treatment were the same terms as for rest, as well as brain training, cervical spine, cognitive therapy, dizziness, exercise, headache, neck, pharmacotherapy, postural balance, and vertigo. The authors included peer-reviewed, published articles and abstracts and performed a citation search. Study Selection: Studies were included based on the following criteria as determined before searching: classified as original research, symptoms resulted after sport-related concussion, and investigation of the effects of either rest or treatment on symptoms. Abstracts that were excluded failed to evaluate rest, omitted sport-related concussion as the cause of symptoms, failed to evaluate a treatment's effect on sport-related concussion, or did not present original research. Data Extraction: The following data were extracted from each study that fit the selection criteria: study design; sample size; participants' demographic information (age and sex); type, duration, and intensity of treatment; key findings including effect sizes and means with 95% confidence intervals (calculated when possible using the data provided in the original study, even if not presented in the original study); and relevant comments. Main Results: The search revealed 749 articles evaluating the effects of rest and 1175 articles evaluating the effects of treatment. Of the 749 articles evaluating the effects of rest, only 2 met all the inclusion criteria. Of the 1175 articles evaluating the effects of treatment, only 10 met all the inclusion criteria. Ultimately, the authors were able to identify additional treatment articles that met the inclusion criteria, for a total of 12. The nature of the treatments and the participants differed enough that meta-analysis was not possible. One of the 2 articles that evaluated rest was a retrospective analysis of athletes that showed those who were prescribed a period of cognitive rest had a longer duration of symptoms. The other study followed athletes postconcussion who were retrospectively assigned to groups based on self-reported activity level after injury. Those who reported moderate levels of cognitive and physical exertion over the first month postinjury appeared to demonstrate improved outcomes compared with those who pursued small or large amounts of activity. Twelve studies evaluated the effects of treatment on symptoms after sport-related concussion. Various interventions were reviewed, including pharmacotherapy, light aerobic activity, graded exercise treadmill test, hyperbaric oxygen therapy, vestibular physiotherapy, and cervical spine manual therapy. Unfortunately, the authors did not report effect sizes for specific interventions, and due to the varied nature of each study and its respective treatment approach, no pooled data could be analyzed. However, a group of adolescents treated with submaximal aerobic and coordination exercises, visualization, and imagery returned to full normal physical activity at a mean duration of 4.4 weeks (95% confidence interval = 3.1, 5.7 weeks). Furthermore, a randomized controlled trial of patients experiencing persistent neck pain, dizziness, and headaches who underwent manual and physical therapy showed they were more likely to return to sport after 8 weeks of treatment. Despite the inability to pool data, the authors concluded that each treatment appeared to positively influence specific aspects of certain patients' symptoms. Conclusions: Little high-quality evidence has addressed the effects of rest and treatment after sport-related concussion. Current evidence suggests that an initial period of rest appears to be beneficial. Further research is needed to evaluate the long-term outcomes of rest (including the quality and quantity of the rest). Low levels of exercise may benefit the athlete postinjury, but additional study is required to determine the optimal timing for initiation of treatment postinjury. Patients with cervical spine or vestibular dysfunction may benefit from rehabilitation techniques targeted

机译：参考：Schneider KJ，Iverson GL，Emery CA，McCrory P，Herring SA，Meeuwisse WH。与运动有关的脑震荡后休息和治疗的影响：对文献的系统评价。 Br J运动医学。 2013; 47（5）：304-307。临床问题：脑震荡和一段时间的症状和有限的身体和认知休息后，经历间歇性症状的运动员在进行体育锻炼时是否比在长时间休息后更快地恢复到无症状状态？数据来源：一位研究者使用以下数据库对每个研究问题进行了单独搜索：CINAHL，Cochrane对照试验注册簿，EMBASE，HealthSTAR，ProQuest，PsychInfo，PubMed，SPORTDiscus和Web of Science。休息的搜索词是脑震荡，认知休息，轻度脑外伤，体力消耗，脑震荡后综合征，康复，与运动有关的脑震荡，治疗，治疗和治疗结局。治疗的搜索字词与休息，脑部训练，颈椎，认知疗法，头晕，运动，头痛，颈部，药物治疗，姿势平衡和眩晕的搜索词相同。作者纳入了同行评审，发表的文章和摘要，并进行了引文检索。研究选择：纳入研究的依据是在搜索前确定的以下标准：分类为原始研究，运动相关性脑震荡后产生的症状以及休息或治疗对症状的影响的调查。被排除的摘要无法评估休息，忽略运动相关性脑震荡作为症状的原因，未能评估治疗方法对运动相关性脑震荡的作用或没有提出原始研究。数据提取：从符合选择标准的每个研究中提取以下数据：研究设计;样本量参与者的人口统计信息（年龄和性别）;治疗的类型，持续时间和强度;关键发现，包括效应大小和均值区间为95％的均值（可能使用原始研究提供的数据进行计算，即使原始研究中未提供）;和相关评论。主要结果：搜索结果发现有749篇文章评估了休息的效果，有1175篇文章评估了治疗的效果。在749篇评估休息效果的文章中，只有2篇符合所有纳入标准。在1175篇评估治疗效果的文章中，只有10篇符合所有纳入标准。最终，作者能够鉴定出符合纳入标准的其他治疗文章，总计12篇。治疗的性质和参与者的差异很大，无法进行荟萃分析。评估休息的2篇文章之一是对运动员的回顾性分析，结果表明，规定了一段时间的认知休息的运动员出现症状的持续时间更长。另一项研究是脑震荡后的运动员，他们根据受伤后自我报告的活动水平回顾性地分组。与那些进行少量或大量运动的人相比，那些在损伤后第一个月内表现出中等水平的认知和身体活动水平的人似乎表现出了改善的结果。十二项研究评估了运动对脑震荡后治疗对症状的影响。审查了各种干预措施，包括药物治疗，轻度有氧运动，分级运动跑步机测试，高压氧治疗，前庭物理治疗和颈椎手动治疗。不幸的是，作者没有报告具体干预措施的效果大小，并且由于每项研究及其各自的治疗方法的不同性质，因此无法分析汇总的数据。但是，一组接受了最大程度的有氧运动和协调运动，可视化和图像处理的青少年，平均持续时间为4.4周（95％置信区间= 3.1、5.7周），恢复了完全正常的体育活动。此外，对经历持续性颈部疼痛，头晕和头痛的患者进行了手动和物理治疗的随机对照试验表明，他们在接受治疗8周后更有可能恢复运动。尽管无法汇总数据，但作者得出的结论是，每种疗法似乎都对某些患者症状的某些方面产生积极影响。结论：运动相关脑震荡后很少有高质量的证据说明休息和治疗的效果。目前的证据表明，最初的休息似乎是有益的。需要进一步的研究来评估休息的长期结果（包括休息的质量和数量）。低水平的运动可能会使运动员受伤后受益，但还需要进行其他研究以确定受伤后开始治疗的最佳时机。颈椎或前庭功能障碍的患者可受益于针对性的康复技术

Physical Activity and Intermittent Postconcussion Symptoms After a Period of Symptom-Limited Physical and Cognitive Rest

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