Kontos Anthony P, Eagle Shawn R, Braithwaite Rock, Preszler Jonathan, Manderino Lisa, Turner Rose L, Jennings Sabrina, Trbovich Alicia, Hickey Robert W, Collins Michael W, McCrea Michael, Nelson Lindsay D, Root Jeremy, Thomas Danny G
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Sports Med. 2023 Dec;51(14):3893-3903. doi: 10.1177/03635465221150214. Epub 2023 Feb 27.
Numerous individual studies suggest that rest may have a negative effect on outcomes following concussion.
To perform a systematic meta-analysis of the effects of prescribed rest compared with active interventions after concussion.
Meta-analysis; Level of evidence, 4.
A meta-analysis (using the Hedges ) of randomized controlled trials and cohort studies was conducted to evaluate the effects of prescribed rest on symptoms and recovery time after concussion. Subgroup analyses were performed for methodological, study, and sample characteristics. Data sources were obtained from systematic search of key terms using Ovid Medline, Embase, Cochrane Database of Systematic Reviews, APA PsycINFO, Web of Science, SPORTDiscus, and ProQuest dissertations and theses through May 28, 2021. Eligible studies were those that (1) assessed concussion or mild traumatic brain injury; (2) included symptoms or days to recovery for ≥2 time points; (3) included 2 groups with 1 group assigned to rest; and (4) were written in the English language.
In total, 19 studies involving 4239 participants met criteria. Prescribed rest had a significant negative effect on symptoms ( = 15; = -0.27; SE = 0.11; 95% CI, -0.48 to -0.05; = .04) but not on recovery time ( = 8; = -0.16; SE = 0.21; 95% CI, -0.57 to 0.26; = .03). Subgroup analyses suggested that studies with shorter duration (<28 days) ( = -0.46; = 5), studies involving youth ( = -0.33; = 12), and studies focused on sport-related concussion ( = -0.38; = 8) reported higher effect sizes.
The findings support a small negative effect for prescribed rest on symptoms after concussion. Younger age and sport-related mechanisms of injury were associated with a greater negative effect size. However, the lack of support for an effect for recovery time and the relatively small overall numbers of eligible studies highlight ongoing concerns regarding the quantity and rigor of clinical trials in concussion.
CRD42021253060 (PROSPERO).
众多个体研究表明，休息可能对脑震荡后的结果产生负面影响。
对脑震荡后规定休息与积极干预的效果进行系统的荟萃分析。
荟萃分析；证据等级，4级。
进行了一项荟萃分析（使用赫奇斯法），纳入随机对照试验和队列研究，以评估规定休息对脑震荡后症状和恢复时间的影响。对方法学、研究和样本特征进行了亚组分析。数据来源通过使用Ovid Medline、Embase、Cochrane系统评价数据库、APA PsycINFO、Web of Science、SPORTDiscus以及ProQuest学位论文和论文数据库，对关键词进行系统检索获得，检索截至2021年5月28日。符合条件的研究为：（1）评估脑震荡或轻度创伤性脑损伤；（2）包括≥2个时间点的症状或恢复天数；（3）包括2组，其中1组被分配至休息组；（4）以英文撰写。
共有19项研究涉及4239名参与者符合标准。规定休息对症状有显著负面影响（n = 15；g = -0.27；SE = 0.11；95%CI，-0.48至-0.05；P = 0.04），但对恢复时间无影响（n = 8；g = -0.16；SE = 0.21；95%CI，-0.57至0.26；P = 0.03）。亚组分析表明，持续时间较短（<28天）的研究（g = -0.46；n = 5）、涉及青少年的研究（g = -0.33；n = 12）以及专注于运动相关脑震荡的研究（g = -0.38；n = 8）报告的效应量更高。
研究结果支持规定休息对脑震荡后症状有较小的负面影响。年龄较小和与运动相关的损伤机制与更大的负面影响量相关。然而，缺乏对恢复时间有影响的证据以及符合条件的研究总数相对较少，凸显了对脑震荡临床试验数量和严谨性的持续担忧。
CRD42021253060（PROSPERO）
