Rest and treatment/rehabilitation following sport-related concussion: a systematic review.
OBJECTIVE
The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).


METHODS
Systematic review.


METHODS
MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically.


METHODS
Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded.


RESULTS
Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care.


CONCLUSIONS
A brief period (24-48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit.


BACKGROUND
PROSPERO 2016:CRD42016039570.
Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
Kathryn J
KJ
Schneider
Department of Orthopaedics, SUNY Buffalo, Buffalo, New York, USA.
John J
JJ
Leddy
Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Kevin M
KM
Guskiewicz
Norton Healthcare, Louisville, Kentucky, USA.
Tad
T
Seifert
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Michael
M
McCrea
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Noah D
ND
Silverberg
Department of Neurology, University Hospital Zurich, Zurich, Switzerland.|Schulthess Clinic, Zurich, Switzerland.
Nina
N
Feddermann-Demont
Physical Medicine and Rehabilitation, Harvard Medical School; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA.
Grant L
GL
Iverson
Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada.
Alix
A
Hayden
Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia.|Olympic Park Sports Medicine Centre, Melbourne, Australia.
Michael
M
Makdissi
D001265:Athletic Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D001924:Brain Concussion / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012146:Rest; D013177:Sports
Concussion; mild traumatic brain injury; rehabilitation; rest; sports; treatment