Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.
Br J Sports Med. 2022 Jul;56(14):801-811. doi: 10.1136/bjsports-2021-104451. Epub 2022 Apr 20.
To examine the progression of collegiate student athletes through five stages of a return-to-activity protocol following sport-related concussion (SRC).
In a multisite prospective cohort study, we identified the frequency of initial 24-48 hours physical and cognitive rest, and the sequence of (1) symptom resolution and return to (2) exertion activity, (3) limited sport, (4) full sport and (5) full academics. In resulting profiles we estimated the likelihood of return to full sport ≤14 days or prolonged >28 days and tested for variability based on timing of the stages.
Among 1715 athletes with SRC (31.6% females), 67.9% had 24-48 hours initial physical and cognitive rest. The median was 6 days to return to full academics, 8 days to symptom resolution and 9 days to exertion. Three profiles emerged; all had the same sport-specific return progression, but varied in the relative timing of full academics. In unadjusted analyses, full academics as the first stage corresponded to the longest time to return to full sport, and initiating exertion the same day as symptom resolution resulted in the shortest time. In adjusted regression analyses, athletes initiating full academics while still symptomatic were 21.5% less likely (95% CI -27.4% to -15.5%) to return to full sport ≤14 days and, analogously, 19.1% more likely (95% CI 13.4% to 24.7%) to have prolonged return >28 days. While additionally controlling for initial rest, sex, symptom count and concussion history, the likelihood of prolonged return >28 days was 37.0% (95% CI 25.2% to 48.8%) in athletes initiating exertion considerably before symptoms resolved (ie, 7+ days), but only 3.6% (95% CI -1.4% to 8.6%) in athletes initiating exertion shortly before achieving symptom resolution (ie, 3-4 days).
We found evidence that sequential progressions were consistent with current recommendations including brief initial rest, and the initiation and relative timing of each stage impacted the final return-to-sport outcome.
通过运动相关脑震荡（SRC）后活动恢复方案的五个阶段，检查大学生运动员的进展情况。
在一项多地点前瞻性队列研究中，我们确定了初始 24-48 小时内身体和认知休息的频率，以及（1）症状缓解和（2）恢复活动、（3）限制运动、（4）全面运动和（5）全面学业的顺序。在得出的特征中，我们估计了 14 天内恢复全面运动的可能性≤或 28 天以上的可能性，并根据各阶段的时间进行了可变性测试。
在 1715 名 SRC 运动员（31.6%为女性）中，67.9%在初始时有 24-48 小时的身体和认知休息。中位数为 6 天恢复全面学业，8 天症状缓解，9 天恢复活动。出现了三种特征；所有的运动特定恢复进展相同，但全面学业的相对时间不同。在未调整的分析中，以学业为第一阶段与恢复全面运动的时间最长相对应，而在症状缓解的同一天开始运动则导致最短的时间。在调整后的回归分析中，在症状仍未缓解时就开始全面学业的运动员，在 14 天内恢复全面运动的可能性低 21.5%（95%置信区间-27.4%至-15.5%），同样地，28 天以上恢复的可能性高 19.1%（95%置信区间 13.4%至 24.7%）。虽然还同时控制了初始休息、性别、症状数和脑震荡史，但在症状缓解前几天（即 7 天以上）开始运动的运动员，其 28 天以上恢复的可能性为 37.0%（95%置信区间 25.2%至 48.8%），而在症状缓解前几天（即 3-4 天）开始运动的运动员，其 28 天以上恢复的可能性仅为 3.6%（95%置信区间-1.4%至 8.6%）。
我们发现证据表明，连续进展与当前的建议一致，包括短暂的初始休息，以及每个阶段的开始和相对时间都会影响最终的重返运动结果。
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