Wilson Julie C, Kirkwood Michael W, Potter Morgan N, Wilson Pamela E, Provance Aaron J, Howell David R
Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, United States.
Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States.
J Clin Transl Res. 2020 Apr 16;5(4):161-168. eCollection 2020 May 26.
The objective of the study was to evaluate the clinical outcomes among patients who did and did not report engaging in early physical activity (PA) following sport-related concussion.
We evaluated pediatric patients seen within 21 days of concussion. The independent variable was early PA engagement (since the injury and before initial clinical evaluation). Dependent variables included demographics, injury details, medical history, Health and Behavior Inventory (HBI) score, and balance, vestibular, and oculomotor function tests.
We examined data from 575 pediatric patients: Sixty-nine (12%) reported engaging in early PA (mean age=14.3±2.4 years; 30% female). The no PA group (mean age=14.5±2.4 years; 35% female) had significantly longer symptom resolution times than the early PA group (median= 16 [interquartile range (IQR)=8-24] vs. 10.5 [IQR=4-17] days; p=0.02). When controlling for pre-existing headache history and time from injury-evaluation time, the early PA group demonstrated lower odds of reporting current headache (adjusted odds ratio=0.14; 95% CI=0.07, 0.26), and reported lower symptom frequency ratings than the no PA group (b=-5.58, 95% CI=-8.94, -2.22).
Patients who did not engage in early PA had longer symptom duration, greater odds of post-injury headache, and greater symptoms at initial clinical evaluation. We cannot determine if patients engaged in early PA due to the lower symptom burden and higher functioning at the time of assessment, or if early PA positively affected outcomes. However, as early PA was associated with better post-injury outcomes, clinicians may consider supervised and structured early PA programs as a method to improve clinical outcomes following concussion.
Children and adolescents who were engaged in PA after concussion presented to a clinic with less severe symptoms and had symptoms that resolved sooner compared to those who did not engage in early PA after concussion.
本研究的目的是评估在与运动相关的脑震荡后报告和未报告进行早期体育活动（PA）的患者的临床结局。
我们评估了在脑震荡后21天内就诊的儿科患者。自变量是早期PA参与情况（自受伤后至首次临床评估前）。因变量包括人口统计学、损伤细节、病史、健康与行为量表（HBI）评分以及平衡、前庭和动眼功能测试。
我们检查了575名儿科患者的数据：69名（12%）报告进行了早期PA（平均年龄=14.3±2.4岁；30%为女性）。未进行PA组（平均年龄=14.5±2.4岁；35%为女性）的症状缓解时间明显长于早期PA组（中位数=16[四分位间距（IQR）=8 - 24]天 vs. 10.5[IQR=4 - 17]天；p = 0.02）。在控制既往头痛病史和从受伤到评估的时间后，早期PA组报告当前头痛的几率较低（调整后的优势比=0.14；95%置信区间=0.07，0.26），并且报告的症状频率评分低于未进行PA组（b = -5.58，95%置信区间=-8.94，-2.22）。
未进行早期PA的患者症状持续时间更长，受伤后头痛的几率更高，且在首次临床评估时症状更严重。我们无法确定患者是由于评估时症状负担较低和功能较好而进行早期PA，还是早期PA对结局产生了积极影响。然而，由于早期PA与更好的受伤后结局相关，临床医生可考虑将有监督的结构化早期PA计划作为改善脑震荡后临床结局的一种方法。
与脑震荡后未进行早期PA的儿童和青少年相比，脑震荡后进行PA的儿童和青少年到诊所就诊时症状较轻，且症状缓解更快。
