title: Benefits of strict rest after acute concussion: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).
  
  
  METHODS
  Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.
  
  
  RESULTS
  Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P < .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P < .03) and slower symptom resolution.
  
  
  CONCLUSIONS
  Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest.
authors.affiliation: Departments of Pediatrics, dthomas@mcw.edu.
authors.forename: Danny George
authors.initials: DG
authors.lastname: Thomas
authors.affiliation: Psychiatry and Behavioral Medicine, and.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Apps
authors.affiliation: Departments of Pediatrics.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.affiliation: Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Michael
authors.initials: M
authors.lastname: McCrea
authors.affiliation: Psychiatry and Behavioral Medicine, and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hammeke
mesh_terms: D000293:Adolescent; D001510:Bed Rest; D001924:Brain Concussion / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D003289:Convalescence; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D016014:Linear Models; D008297:Male; D009483:Neuropsychological Tests; D010351:Patient Discharge; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D004856:Postural Balance; D011446:Prospective Studies; D014922:Wisconsin; D055815:Young Adult
keywords: adolescent; brain injury; concussion; discharge instructions; rest