McLeod Tamara C Valovich, Lewis Joy H, Whelihan Kate, Bacon Cailee E Welch
Athletic Training Programs and.
School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa.
J Athl Train. 2017 Mar;52(3):262-287. doi: 10.4085/1052-6050-51.6.06.
To systematically review the literature regarding rest and return to activity after sport-related concussion.
The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity.
Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression.
The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article.
Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables.
Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.
系统回顾有关运动性脑震荡后休息及恢复活动的文献。
在Cochrane对照试验中央注册库、护理学与健康领域数据库、体育科学数据库、教育资源信息中心、Ovid MEDLINE及PubMed中进行检索，使用与脑震荡、轻度创伤性脑损伤、身体和认知休息以及恢复活动相关的术语。
纳入的研究需符合以下条件：以英文发表；为原创研究；评估身体或认知休息的使用、依从性或有效性，或提供支持分级恢复活动进程的实证证据。
根据情况从每篇文章中提取研究设计、患者或参与者样本、所采用的干预措施、结局指标、主要结果及结论。
根据文章对感兴趣的主要临床问题之一的解决能力进行分组：休息的使用、休息效果、对建议的依从性或分级恢复活动进程后的结局。提供了结果的定性综合分析以及汇总表。
我们的主要研究结果表明，医疗保健提供者对休息的使用不足，休息建议宽泛且未针对个体患者，急性期适度的身体和认知休息（如有限的体力活动和轻度脑力活动）可能会改善损伤后的结局，评估工具的使用和对推荐的恢复活动指南的依从性存在显著差异，需要更多研究以实证评估分级恢复活动进程的有效性。此外，迫切需要将脑震荡管理的最佳实践知识传授给初级保健提供者。
