Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
Br J Sports Med. 2017 Jun;51(12):958-968. doi: 10.1136/bjsports-2016-097470. Epub 2017 May 8.
To conduct a systematic review of the literature regarding assessment and treatment modalities in patients with persistent symptoms following sport-related concussion (SRC).
We searched Medline, Embase, SPORTSDiscus, PsycINFO, CINAHL, Cochrane library and ProQuest Dissertation & Theses Global electronic databases.
Studies were included if they were original research, reported on SRC as the primary source of injury, included patients with persistent postconcussive symptoms (>10 days) and investigated the role of assessment or treatment modalities.
Of 3225 articles identified in the preliminary search, 25 articles met the inclusion criteria. 11 articles were concerned with assessment and 14 articles with treatment of persistent symptoms following SRC. There were three randomised control trials and one quasi-experimental study. The remainder consisting of cross-sectional studies, historical cohorts and case series.
'Persistent symptoms' following SRC can be defined as clinical recovery that falls outside expected time frames (ie, >10-14 days in adults and >4 weeks in children). It does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/or confounding pathologies. A detailed multimodal clinical assessment is required to identify specific primary and secondary processes, and treatment should target specific pathologies identified. There is preliminary evidence supporting the use of symptom-limited aerobic exercise, targeted physical therapy and a collaborative approach that includes cognitive behavioural therapy. Management of patients with persistent symptoms is challenging and should occur in a multidisciplinary collaborative setting, with healthcare providers with experience in SRC.
对与运动相关的脑震荡（SRC）后持续性症状的评估和治疗方式进行系统综述。
我们检索了 Medline、Embase、SPORTSDiscus、PsycINFO、CINAHL、Cochrane 图书馆和 ProQuest Dissertations & Theses Global 电子数据库。
如果研究为原始研究，以 SRC 为主要损伤源，纳入持续性脑震荡后症状（>10 天）患者，并探讨评估或治疗方式的作用，则纳入研究。
在初步搜索中确定了 3225 篇文章，其中 25 篇符合纳入标准。11 篇文章关注 SRC 后持续性症状的评估，14 篇文章关注治疗。有三项随机对照试验和一项准实验研究。其余的包括横断面研究、历史队列和病例系列研究。
SRC 后的“持续性症状”可定义为临床恢复超出预期时间框架（即成人>10-14 天，儿童>4 周）。它不反映单一的病理生理实体，而是描述一系列非特异性创伤后症状，可能与共存和/或混杂的病理有关。需要进行详细的多模式临床评估，以确定特定的原发性和继发性过程，并且治疗应针对确定的特定病理。有初步证据支持使用症状限制有氧运动、靶向物理治疗和包括认知行为疗法在内的协作方法。持续性症状患者的管理具有挑战性，应在具有 SRC 经验的多学科协作环境中进行。
