title: The relationship between adherence behaviors and recovery time in adolescents after a sports-related concussion: an observational study.
abstract: BACKGROUND
  Adherence to rehabilitation is widely accepted as vital for recovery and return to play following sports injuries. Medical management of concussion is centered around physical and cognitive rest, a theory largely based on expert opinion, not empirical evidence. Current research on this topic focuses on factors that are predictive of adherence to rehabilitation, but fails to examine if patient adherence leads to a better outcome. The purpose of this study was to determine the adherence tendencies of adolescents to treatment recommendations provided by a sports-medicine physician after a concussion and to determine if adherence to each recommendation was a predictor of treatment duration.
  
  
  METHODS
  Observational.
  
  
  METHODS
  Participants were enrolled in the study at their initial visit to the Sports-Medicine Center for medical care after a sports-related concussion. Individual treatment recommendations provided by a sports-medicine physician for concussion were recorded over the course of each participant's care. Once released from medical care, each participant was contacted to complete an online questionnaire to measure self-reported adherence tendencies to each treatment recommendation. Adherence was measured by two constructs: 1) the reported receptivity to the recommendation and 2) the frequency of following the recommendation. Exploratory univariate Poisson regression analyses were used to describe the relationship between adherence behaviors and the number of days of treatment required before the participant was returned to play.
  
  
  RESULTS
  Fifty-six questionnaires were completed, by 30 male and 26 female adolescent athletes. The self-reported adherence tendencies were very high. None of the measures of adherence to the treatment recommendations were significant predictors of the number of days of treatment; however, there was a clear tendency in five of the six rest parameters (physical rest, cognitive rest with restrictions from electronics, and cognitive rest with restrictions from school), where high levels of adherence to rest resulted in an increased average number of days of treatment (slower recovery) and those who reported being less adherent recovered faster.
  
  
  CONCLUSIONS
  Adolescents were generally adherent to the physician recommendations. Those participants who reported being less adherent to physical and cognitive rest generally recovered faster than those who reported higher levels of adherence to these recommendations. As time progresses after the initial injury, physical and mental rest may be less effective to hasten recovery than more active treatment recommendations.
  
  
  METHODS
  Level 2.
authors.affiliation: Walsh University,Department of Physical Therapy, 2020 E. Maple Street, North Canton, Oh 44720.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Moor
authors.affiliation: Walsh University,Department of Physical Therapy, 2020 E. Maple Street, North Canton, Oh 44720.
authors.forename: Rita C
authors.initials: RC
authors.lastname: Eisenhauer
authors.affiliation: Walsh University,Department of Physical Therapy, 2020 E. Maple Street, North Canton, Oh 44720.
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Killian
authors.affiliation: Walsh University,Department of Physical Therapy, 2020 E. Maple Street, North Canton, Oh 44720.
authors.forename: Nick
authors.initials: N
authors.lastname: Proudfoot
authors.affiliation: Walsh University,Department of Physical Therapy, 2020 E. Maple Street, North Canton, Oh 44720.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Henriques
authors.affiliation: Akron Children's Hospital, Center for Orthopedics and Sports Medicine, Considine Professional Building, 215 W. Bowery St., Suite 7300, Akron, OH 44308.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Congeni
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Reneker
keywords: Adherence; adolescent; concussion; recovery; rest