Article Contents
Clin Exp Pediatr > Volume 67(11); 2024 |
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Funding
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author contribution
Conceptualization: AMPS, RSI, ST; Data curation: AGMG, MG, FK, E; Formal analysis: AI, AGMG, MG, FK, E; Funding acquisition: None; Methodology: AMPS, RSI, ST, AI; Project administration: AMPS, AGMG, MG, FK, E; Visualization: AMPS, AGMG, MG, FK, E, AI; Writing - original draft: AMPS, AGMG, MG, FK, E, AI; Writing - review & editing: AMPS, AI, RSI, ST, AGMG, MG, FK, E
No. | Study | Study design and setting | Country of origin |
Population |
Intervention |
Outcome |
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Primary cause of injury | Characteristics (n) | Intervention | Time since concussion | Duration of treatment | Primary outcome | Primary outcome measure and assessment time | Important findings/adverse events/conclusion | ||||
1 | Chan et al., [16] 2018 | Single-site parallel open-labelRCT | USA | Sportrelated | 12–18Yr | Active rehabilitation program | >1Mo | Over 6 wk | >2 Persistent postconcussion symptoms | Monitored for predetermined adverse events in weekly telephone calls over the 6-wk intervention period | The results support the safety, tolerability, and potential efficacy of active rehabilitation for adolescents with persistent postconcussion symptoms. |
N=19: control (n=9), intervention (n= 10) | Aerobic training, coordination exercises, and visualization and imagery techniques with a physiotherapist | The primary efficacy outcome was self-reported postconcussion symptoms, assessed with 99 the PCSS | |||||||||
2 | Choi et al., [17] 2020 | RCT, single blind, multicentertrial | South Korea | Activity related | 3-16 Yr (mean age: 5 yr 8 mo) | Virtual reality and conventional occupational therapy | 4Wk | 30 minute virtual reality and 30 minute conventional occupational therapy | Improvement postconcussion symptoms | Melbourne Assessment of Unilateral Upper Limb Function-2, The Upper Limb Physician’s Rating Scale, the Pediatric Evaluation of Disability Inventory Computer Adaptive Test | Improvement in unimanual dexterity, performance of activities daily living, and forearm articular movement compared with the control group. |
N=80: control (n=40), intervention (n= 40) | |||||||||||
3 | Carney et al., [18] 2016 | RCT | Argentina | Trauma | <19Yr | Standardcare group and family intervention group | 2-3Days | 6-Mo duration intervention | Effect of postconcussion symptoms | PedsQL module, the PedsQL cognitive scale module, the POPC and PCPC | Children with better outcomes lived with families reporting better function at 6-mo postinjury. |
N=274: control (n=138), intervention (n= 135) | |||||||||||
4 | Kontos et al., [19] 2021 | RCT, doubleblind | USA | Sportrelated | 12–18Yr | Vestibular intervention group and behavioral management control group | 4Wk | 30 Min/day | Improvement Postconcussion symptoms | Vestibular Ocular Motor Screening, Dizziness Handicap Inventory, Modified Balance Error System, PCSS | Both groups improved similarly dizziness, overall concussion experience more pronounced clinical improvement in vestibular items than a behavioral management control group. |
N=50: control (n=25), intervention (n= 25) | |||||||||||
5 | Sufrinko et al., [20] 2017 | RCT (secondary analysis) | USA | N/A | 11–18Yr | Response to prescribed rest between patients with signs of injury vs. patients with symptoms only | 24Hr | 5 Days | PCSS, ImPACT, BESS | ImPACT and PCSS were evaluated at the ED, day 3, and day 10 after injury. | Prescribed rest was associated with improvement in symptoms and verbal memory for patients with signs of injury. |
N=93: control (n=46), intervention (n= 48) | The BESS was evaluated at the ED with only the 3 conditions with feet on the floor, although at the 3-day follow-up, all 6 balance conditions were administered. | However, prescribed rest was found to worsen symptoms for patients withsymptomsonly | |||||||||
6 | Hadanny et al., [21] 2022 | RCT | Israel | Activity related | 8–15Yr | Compare beneficial effect of HBOT group and sham control group | Months to years | 60 days/3 months | The general cognitive score was significantly improved HBOT compared to the sham group | Computerized cognitive health assessment (Neuro Trax Corporation), trail making test, PedsQL and the BESS | HBOT induces significant improvements in cognitive function, Persistent postconcussion syndrome, behavioral symptoms and quality of life. |
N=25: control (n=10), ntervention (n= 15) | |||||||||||
7 | Thomas et al., [26] 2015 | RCT | USA | Any associated mechanism with the potential to have sustained direct force or transmitted force to the head (eg, motor vehicle collision,fall). | 13.7 (12.4–15.0) Yr | Strict rest for 5 days | Within 24hr | 10 Days | To measure compliance with discharge instructions as well as the effect of those instructions on short-term outcomes (first 10 days). | Three-Day Activity Diary and Seven-Day Activity Diary were used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms (PCSS) for 10 days. | The intervention group reported more daily postconcussive symptoms and slower symptom resolution overthe usualcare |
N=99: control (n=50), intervention (n= 49) | ImPACT, BESS, and Ancilary Neuropsychiatric were performed at day 3 and day 10 postinjury. | ||||||||||
8 | Kurowski et al., [27] 2017 | Partially blinded, pilot, RCT | USA | NS | 12–17 Yr | Aerobic exercise | 4-16wk | At least 6 wk (Participants who had not returned to preinjury symptom level continued the program for up to 2 additional wk) | Self-rated postconcussion symptom | The PCSI was used to obtain symptom ratings preinjury, pre-intervention (week 0 and 1), at interval visits (weeks 2 – 9), and after the run-out period at the final assessment. | Greater rate of improvement in the subsymptom exacerbation aerobic training compared to the full-body stretching group |
N=30: control (n=15), intervention (n= 15) | |||||||||||
9 | Bailey et al., [24] 2019 | Pilot, RCT | USA | NS | 14–18 Yr | Subsymptom threshold exercise program | ≥4Wk | 6 Wk | Postconcussion symptom endorsement | PCS-R and BDI-II were evaluated at the baseline, 3 weeks (midpoint), and 6wk (follow-up) | After removing the influence of depression, the intervention group showed significant improvement more than the control group |
N=15: control (n=8), intervention (n= 77) | |||||||||||
10 | McCarty et al., [23] 2016 | RCT | USA | Sports related | 11–17 Yr | Collaborative care intervention | ≥1 Mo | 6 Mo | Postconcussive Symptoms and Depressive Symptoms | Postconcussive Symptoms was evaluated using Health and Behavior Inventory, and Depressive Symptoms was evaluated using The Patient Health Questionnaire, The PROMIS - PA8, PedsQL. The following set of measures were administered at baseline and 1,3, and 6 months | Six months after the baseline assessment, 13.0% of intervention patients and 41.7% of control patients reported high levels of postconcussive symptoms (P=0.03), and 78% of intervention patients and 45.8% of control patients reported ≥50% reduction in depression symptoms (P=0.02) |
N=49: control (n=24), intervention (n= 25) | |||||||||||
11 | Leddy et al., [25] 2019 | RCT | USA | Sport related | 13–18 Yr | Progressive subsymptom threshold aerobic exercise | 10 Days | 30 Days | Days to recovery since date of injury | Patients reported PCSS on a website until they were declared recovered by the physician or for 30 days, whichever came first | Those assigned to aerobic exercise recovered faster (13 days) than those assigned to placebo-like stretching (17 days). |
N=103: control (n=51), intervention (n= 52) | |||||||||||
12 | Dobney et al., [28] 2020 | RCT | Canada | Not-specified | 6–17 Yr | Active rehabilitation (aerobic exercise, coordination drills, visualization, and education/reassurance) was administered by physiotherapists inperson, and then continued as a home program | 3 Wk | Early AR (initiated 2 weeks after injury) or standard AR (initiated 4 weeks after injury) | PCSI (headache, nausea, balance problems, dizziness, fatigue, sadness, and nervous/anxious). | Online surveys were emailed to all participants everyday starting after the 2-wk physiotherapy appointment until one of the following criteria were met: (1) the end of the study period (8wk), (2) the patient reported 5 consecutive days of being symptom-free, or (3) the patient was discharged by physical therapy | The results from this pilot study indicate that a full clinical trial estimating the efficacy of early AR (starting 2 wk after injury) is feasible. Further study is needed to determine the superiority of this strategy over current treatment approaches |
N=20: control (n=10), intervention (n= 10) | |||||||||||
13 | Micay et al., [22] 2018 | RCT | USA | Sport-related | 14–18 Yr | Aerobic exercise intervention | 5Days | This intensity was maintained at the next session, however, the session was increased to 20 min in duration. | Postconcussion symptom | PCSS scores were collected before and after each exercise session and symptoms were monitored throughout exercise using a prepared script | A structured AE protocol appears to be safe and feasible to administer in the postacute stage of SRC recovery in adolescents and should be explored as part of a full Phase III Clinical Trial. |
Mean age: 15.6–15.8 yr | |||||||||||
N=15: control (n=7), intervention (n=8) | Exerciseoccurred on 2 consecutive days, followed by 1 day of rest, for a total of 11 days. |
RCT, randomized controlled trial; PCSS, postconcussion symptom scale; PCSI, postconcussion symptom inventory; PedsQL, pediatric quality of life inventory; BESS, balance error scoring system; HBOT, hyperbaric oxygen therapy; POPC, pediatric overall performance category; PCPC, pediatric cerebral performance category; ImPACT, international mission for prognosis and clinical trial; ED, Emergency Department ; PCS-R, postconcussion scale–revised; BDI-II , Beck Depression Inventory, 2nd edition; PROMIS-PA8, Patient-Reported Outcomes Measurement Information System; AR, active rehabilitation; AE, aerobic exercise.