GF Strong Rehab Centre, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA; MassGeneral Hospital for Children Sport Concussion Program, Boston, MA.
Arch Phys Med Rehabil. 2018 Feb;99(2):242-249. doi: 10.1016/j.apmr.2017.09.108. Epub 2017 Oct 5.
To examine the safety and tolerability of an active rehabilitation program for adolescents who are slow to recover from a sport-related concussion, and secondarily to estimate the treatment effect for this intervention.
Single-site, parallel, open-label, randomized controlled trial comparing treatment as usual (TAU) to TAU plus active rehabilitation.
Outpatient concussion clinic.
Adolescents (N=19) aged 12 to 18 years with postconcussion symptoms lasting ≥1 month after a sports-related concussion.
TAU consisted of symptom management and return-to-play advice, return-to-school facilitation, and physiatry consultation. The active rehabilitation program involved in-clinic subsymptom threshold aerobic training, coordination exercises, and visualization and imagery techniques with a physiotherapist (mean, 3.4 sessions) as well as a home exercise program, over 6 weeks.
A blinded assessor systematically monitored for predetermined adverse events in weekly telephone calls over the 6-week intervention period. The treating physiotherapist also recorded in-clinic symptom exacerbations during aerobic training. The Post-Concussion Symptom Scale was the primary efficacy outcome.
Nineteen participants were randomized, and none dropped out of the study. Of the 12 adverse events detected (6 in each group), 10 were symptom exacerbations from 1 weekly telephone assessment to the next, and 2 were emergency department visits. Four adverse events were referred to an external safety committee and deemed unrelated to the study procedures. In-clinic symptom exacerbations occurred in 30% (9/30) of aerobic training sessions, but resolved within 24 hours in all instances. In linear mixed modeling, active rehabilitation was associated with a greater reduction on the Post-Concussion Symptom Scale than TAU only.
The results support the safety, tolerability, and potential efficacy of active rehabilitation for adolescents with persistent postconcussion symptoms.
研究一种针对运动相关性脑震荡后恢复缓慢的青少年的主动康复方案的安全性和耐受性，其次是评估该干预措施的治疗效果。
单站点、平行、开放标签、随机对照试验，比较常规治疗（TAU）与 TAU 加主动康复。
门诊脑震荡诊所。
年龄在 12 至 18 岁之间的青少年，在运动相关性脑震荡后出现持续超过 1 个月的脑震荡后症状。
TAU 包括症状管理和重返运动建议、重返学校促进以及物理治疗师咨询。主动康复计划包括门诊亚症状阈有氧运动、协调运动以及可视化和意象技术，以及物理治疗师指导的家庭运动计划，为期 6 周。
在 6 周干预期间，通过每周电话随访，由盲法评估者系统监测预定的不良事件。治疗物理治疗师还记录了在有氧运动训练过程中的门诊症状加重情况。使用脑震荡后症状量表作为主要疗效指标。
19 名参与者被随机分配，没有一人退出研究。在检测到的 12 起不良事件中（每组各 6 起），有 10 起是从每周一次的电话评估到下一次评估时出现的症状加重，有 2 起是急诊就诊。4 起不良事件被转介给外部安全委员会，认为与研究程序无关。在 30%（9/30）的有氧运动训练课程中出现了门诊症状加重，但在所有情况下都在 24 小时内得到解决。在线性混合模型中，主动康复组在脑震荡后症状量表上的得分比 TAU 组有更大的降低。
结果支持主动康复对持续存在脑震荡后症状的青少年的安全性、耐受性和潜在疗效。
