Chrisman Sara P D, Whitlock Kathryn B, Mendoza Jason A, Burton Monique S, Somers Ellie, Hsu Albert, Fay Lauren, Palermo Tonya M, Rivara Frederick P
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.
Department of Pediatrics, University of Washington, Seattle, WA, United States.
Front Neurol. 2019 Jun 17;10:623. doi: 10.3389/fneur.2019.00623. eCollection 2019.
To evaluate feasibility and acceptability of a sub-threshold exercise program with minimal in-person visits to treat youth with persistent sport-related concussion, and explore efficacy for improving concussive symptoms, health-related quality of life, and fear-avoidance. We conducted a pilot randomized controlled trial comparing a 6 week sub-threshold exercise program requiring only two in-person visits to active control (stretching) for 12-18 year old youth with persistent sport-related concussion. We measured moderate-to-vigorous physical activity pre- and post-intervention using accelerometry, and increased goals weekly via phone contact. We examined feasibility and acceptability using qualitative interviews. We used exponential regression to model differences in trajectory of concussive symptoms by experimental group, and linear regression to model differences in trajectory of health-related quality of life and fear-avoidance of pain by experimental group. Thirty-two subjects randomized, 30 completed the study ( = 11 control, = 19 intervention), 57 female. Youth and parents reported enjoying participating in the study and appreciated the structure and support, as well as the minimal in-person visits. Exponential regression modeling indicated that concussive symptoms declined more rapidly in intervention youth than control ( = 0.02). Health-related quality of life and fear-avoidance of pain improved over time, but were not significantly different by group. This study indicates feasibility and potential benefit of a 6 week subthreshold exercise program with minimal in-person visits for youth with persistent concussion. Potential factors that may play a role in improvement such as fear-avoidance deserve further study.
为评估一种亚阈值运动计划的可行性和可接受性，该计划只需极少的面对面就诊次数即可治疗患有持续性运动相关脑震荡的青少年，并探索其在改善脑震荡症状、健康相关生活质量和恐惧回避方面的疗效。我们进行了一项试点随机对照试验，比较了一项为期6周的亚阈值运动计划（该计划仅需两次面对面就诊）与主动对照（伸展运动）对12至18岁患有持续性运动相关脑震荡的青少年的效果。我们使用加速度计测量干预前后的中度至剧烈身体活动，并通过电话联系每周增加目标。我们通过定性访谈来检查可行性和可接受性。我们使用指数回归来模拟实验组脑震荡症状轨迹的差异，使用线性回归来模拟实验组健康相关生活质量轨迹和疼痛恐惧回避的差异。32名受试者被随机分组，30人完成了研究（对照组11人，干预组19人），57名女性。青少年和家长报告称喜欢参与该研究，并赞赏其结构、支持以及极少的面对面就诊次数。指数回归模型表明，干预组青少年的脑震荡症状下降速度比对照组更快（P = 0.02）。健康相关生活质量和疼痛恐惧回避随时间有所改善，但两组之间无显著差异。这项研究表明，对于患有持续性脑震荡的青少年，一项为期6周、只需极少面对面就诊次数的亚阈值运动计划具有可行性和潜在益处。可能在改善过程中起作用的潜在因素，如恐惧回避，值得进一步研究。
