title: Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.
abstract: OBJECTIVE
  Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion.
  
  
  METHODS
  Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.
  
  
  METHODS
  Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature.
  
  
  METHODS
  Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified.
  
  
  RESULTS
  Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation.
  
  
  CONCLUSIONS
  Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in this population. Further high-level studies evaluating the effects of VRT in patients with mTBI/concussion with vestibular and/or balance dysfunction are required.
authors.affiliation: School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Murray
authors.affiliation: School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland.
authors.forename: Dara
authors.initials: D
authors.lastname: Meldrum
authors.affiliation: School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
authors.forename: Olive
authors.initials: O
authors.lastname: Lennon
mesh_terms: D001265:Athletic Injuries / Q000175:diagnosis / Q000534:rehabilitation; D001924:Brain Concussion / Q000175:diagnosis / Q000534:rehabilitation*; D004244:Dizziness / Q000175:diagnosis / Q000534:rehabilitation; D005081:Exercise Therapy; D006801:Humans; D026741:Physical Therapy Modalities; D004856:Postural Balance; D016032:Randomized Controlled Trials as Topic; D000068958:Return to Sport; D014717:Vertigo / Q000175:diagnosis / Q000534:rehabilitation; D015837:Vestibular Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D014722:Vestibule, Labyrinth / Q000503:physiopathology
keywords: Brain; Concussion; Contact sports; Rehabilitation