University of British Columbia, Vancouver, British Columbia, Canada.
Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada.
Pediatrics. 2023 May 1;151(5). doi: 10.1542/peds.2022-059592.
Concussions in youth are highly prevalent. Previously, rest was prescribed to prevent adverse outcomes; however, early return to activity is emerging to improve the recovery trajectory.
To evaluate the effectiveness of early return to physical and social activity interventions on recovery outcomes in youth with concussion.
A systematic review was conducted up to October 2022.
We included randomized controlled trials (RCTs) and non-RCTs that reported effects of activity-based interventions on symptoms, quality-of-life (QoL), and return to preinjury activity levels in children and youth after a concussion.
Three authors independently extracted data on publication year and country, study setting and design, sample size, participant demographics, intervention, outcome(s), and author conclusion. Meta-analysis was conducted on appropriate RCTs.
Twenty-four studies were included in the final review, of which 10 were RCTs. There was a significant effect of activity interventions on symptom reporting (standardized mean difference, 0.39 [95% confidence interval, 0.15 to 0.63]; I2, 0%; P = .002). There was not a significant effect of activity-based interventions on QoL (mean difference, -0.91 [95% confidence interval, -7.76 to 5.94]; I2, 0%; P = .79). No meta-analysis was performed on return to preinjury activity levels because of insufficient number of RCTs conducted.
One outcome was excluded from the meta-analysis. Interventions emphasizing social activity were lacking.
Findings indicate that activity-based interventions may significantly improve concussion symptoms. There is insufficient data to understand the effect of activity-based intervention on QoL and return to preinjury activity levels.
青少年中脑震荡的发病率很高。以前，为了防止不良后果，建议休息；然而，现在提倡尽早恢复活动，以改善恢复轨迹。
评估早期恢复身体和社会活动干预对青少年脑震荡患者恢复结果的有效性。
系统评价截至 2022 年 10 月。
我们纳入了报告活动干预对儿童和青少年脑震荡后症状、生活质量（QoL）和恢复到受伤前活动水平影响的随机对照试验（RCT）和非 RCT。
三位作者独立提取了关于出版物年份和国家、研究地点和设计、样本量、参与者人口统计学、干预措施、结果以及作者结论的数据。对适当的 RCT 进行了荟萃分析。
最终综述纳入了 24 项研究，其中 10 项为 RCT。活动干预对症状报告有显著影响（标准化均数差，0.39 [95%置信区间，0.15 至 0.63]；I²，0%；P =.002）。基于活动的干预对 QoL 没有显著影响（平均差异，-0.91 [95%置信区间，-7.76 至 5.94]；I²，0%；P =.79）。由于进行的 RCT 数量不足，因此未对恢复到受伤前活动水平进行荟萃分析。
一项结果未纳入荟萃分析。缺乏强调社会活动的干预措施。
研究结果表明，基于活动的干预可能显著改善脑震荡症状。目前尚无足够的数据来了解基于活动的干预对 QoL 和恢复到受伤前活动水平的影响。
