201 Safety of an early, active concussion rehabilitation protocol among professional, collegiate/university, and interscholastic athletes: the active rehab study. (3rd March 2020)

• Record Type: Journal Article
• Authors: Register-Mihalik, Johna; Guskiewicz, Kevin; Marshall, Stephen; McCulloch, Karen; Mihalik, Jason; Mrazik, Martin; Murphy, Ian; Naidu, Dhiren; Ranapuwala, Shabbar; Schneider, Kathryn; Gildner, Paula; Kostogiannes, Vasiliki; McCrea, Michael
• Is Part Of: British journal of sports medicine. Volume 54(2020)Supplement 1
• Page Start: A84
• Page End: A85
• Publication Date: 2020-03-03
• Subjects: Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2020-IOCAbstracts.201
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Background: Secondary and tertiary concussion prevention interventions are at the forefront of improving patient outcomes. Few studies report safety details for such interventions across patient cohorts. Objective: To examine a large international concussion rehabilitation trial's safety outcomes. Design: Non-blinded, cluster-randomized (by site) trial. Setting: Sports medicine clinic and field settings. Patients (or Participants): Participants included professional rugby and Canadian football athletes, and college and high school student-athletes from three countries (Canada, New Zealand, United States) suffering a sport-related concussion. Interventions (or assessment of risk factors): Study arms: 1) 'enhanced graded exertion - EGE': international consensus return to sport strategy and sport specific activities; and 2) 'multidimensional rehabilitation – MDR': symptom directed rehabilitation exercises from the time participants' symptoms were stable throughout recovery; once asymptomatic MDR and EGE activities were integrated. Main outcome measurements: Symptom increases during sessions exceeding a reliable change index (10+ severity points) and reported adverse events (AEs). Results: Session documentation logs (1578 from 251 injured participants, 663 EGE, 915 MDR). Only 9/1578 (<0.6%) individual sessions (6 participants) resulted in symptom increases beyond reliable change. Four sessions were EGE only, one session was MDR only, and four occurred during EGE and MDR integration. Most (8/9) participants' symptoms decreased by the next documented session. Two (1 EGE, 1 MDR) AEs were reported. EGE AE: a collegiate athlete reporting to the ED following worsening headache. Neuroimaging was normal. The participant returned to sport. MDR AE: symptom spike where a professional sport participant's symptom severity score remained elevated at their next session. This participant withdrew from study due to travel away from the site, but fully recovered. Conclusions: Both the EGE and MDR arms appear safe with few symptom increases (<0.6%) and even fewer reported AEs. These data support the safety of such protocols in secondary and tertiary concussion prevention efforts.