title: The effect of recommending cognitive rest on recovery from sport-related concussion.
abstract: OBJECTIVE
  To determine whether recommending cognitive rest to athletes after a sport-related concussion affects time to symptom resolution.
  
  
  METHODS
  A retrospective cohort study was conducted of 184 patients who presented to a sports concussion clinic in an academic medical centre between 1 November 2007 and 31 July 2009. The effect of recommending cognitive rest on symptom duration (days) was measured after adjusting for age, gender, initial PCSS score, history of amnesia, history of loss of consciousness and number of previous concussions. Using multivariate logistic regression, independent predictors of prolonged symptoms were identified, defined as >30 days.
  
  
  RESULTS
  Of the 135 study patients with complete medical records, 85 (63%) had cognitive rest recommended. Of those, 79 (59%) had prolonged symptoms. In the multivariate analysis, only initial PCSS score was associated with the duration of concussion symptoms (adjusted odds ratio (AOR) = 1.03; 95% CI = 1.01-1.05). The recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution (AOR = 0.5; 95% CI = 0.18-1.37).
  
  
  CONCLUSIONS
  Given the limited evidence regarding the effects of cognitive rest on recovery from concussion, recommendations of prolonged periods of cognitive rest, particularly absences from school, should be approached cautiously.
authors.affiliation: Meli Orthopedics, Ft. Lauderdale, FL, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gibson
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Michael
authors.initials: M
authors.lastname: O'Brien
authors.forename: William P
authors.initials: WP
authors.lastname: Meehan
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D001265:Athletic Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D001924:Brain Concussion / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009483:Neuropsychological Tests; D016017:Odds Ratio; D038223:Post-Concussion Syndrome / Q000517:prevention & control* / Q000523:psychology; D011379:Prognosis; D020127:Recovery of Function; D012146:Rest; D012189:Retrospective Studies; D012574:Schools