DeMatteo Carol, Randall Sarah, Jakubowski Josephine, Stazyk Kathy, Obeid Joyce, Noseworthy Michael, Mazurek Michael, Timmons Brian W, Connolly John, Giglia Lucia, Hall Geoffrey, Lin Chia-Yu, Perrotta Samantha
Department of Rehabilitation Sciences, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada, 1 9055259140.
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
JMIR Pediatr Parent. 2024 Oct 9;7:e57325. doi: 10.2196/57325.
Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1-17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population.
This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury.
Children and youth (N=139) aged 5-18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution.
For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3).
Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols.
脑震荡，即轻度创伤性脑损伤，是一个日益受到关注的公共卫生问题，每年影响约1.2%的人口。在1至17岁的儿童中，与其他损伤类型相比，脑震荡的加权患病率最高，这凸显了在青年人群中解决这一问题的重要性。
本研究旨在评估脑震荡青年对恢复活动（RTA）方案的依从性，并确定更好的依从性是否会影响恢复时间和再次受伤率。
招募了5至18岁患有脑震荡的儿童和青年（N=139）。每48小时监测一次自我报告的症状和恢复方案阶段，直至症状消失。使用ActiGraph评估每日加速度计数据。根据与RTA阶段相对应的身体活动临界点收集数据，以评估对RTA方案的依从性。在招募时、症状消失时以及症状消失后3个月，使用一系列身体、认知和行为测量方法对参与者进行评估。
对于RTA第1阶段，根据加速度计数据，共有13%的参与者依从，而第2阶段和第3阶段的依从率分别为11%和34%。主观报告依从RTA方案的参与者症状消失的中位时间为13天，主观报告不依从的参与者为20天（P=0.03）。在RTA方案的自我报告依从性与客观加速度计依从性之间，以及与其他临床结果（如抑郁、生活质量和平衡）之间，未发现显著一致性。整个队列中的再次受伤率为2%（n=3）。
总体而言，使用加速度计评估时，脑震荡后对分阶段方案的依从性极低，但自我报告的依从性较高。RTA方案中规定的更多身体活动限制导致依从性较低。尽管客观依从性较低，但再次受伤率低于预期，这表明监测具有保护作用，且青年对方案的认识有所提高。本研究结果支持转向限制较少的方案，并更早恢复日常活动，这一点已在最近的方案中得到实施。
