Moser Nicholas, Popovic Milos R, Kalsi-Ryan Sukhvinder
KITE Research Institute-University Health Network, Toronto, ON, Canada.
Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Biomed Eng Online. 2025 Apr 25;24(1):48. doi: 10.1186/s12938-025-01380-x.
Post-concussion syndrome is a challenging condition to manage for even the most experienced chronic pain experts. Patients' presentations are heterogeneous with symptoms spanning physical, cognitive and emotional domains. The symptoms reported are often non-specific, making it difficult for health professionals to prescribe effective rehabilitation. The aim of the present study was to examine the effectiveness of a customized rehabilitation program based on subgroup determination following a standardized clinical exam in adults with post-concussion syndrome.
A total of 16 adults (mean age ± SD, 38.3 ± 12.5 years) with post-concussion syndrome participated in a 6-week rehabilitation program. Participants were recruited from external community concussion clinics around the greater Toronto area, Canada. Participants underwent a comprehensive standardized clinical exam to subgroup the ostensible symptom generators into either autonomic, cervical or vestibulo-ocular. Customized rehabilitation was then prescribed based on their subgroupings. The primary outcome measure was the Rivermead Post-Concussion Questionnaire (RPQ). Secondary outcome measures included the Patient Health Questionnaire-9 (PHQ-9), the Neck Disability Index (NDI), and exercise tolerance as assessed via the Buffalo Concussion Treadmill Test (BCTT).
Following 6 weeks of customized rehabilitation, participants on average experienced a significant and clinically meaningful change with respect to the RPQ-3 and RPQ-13 (p < 0.001). We also observed a significant change in all secondary outcome measures including a reduction in PHQ-9 (p < 0.01), NDI (p < 0.001) and exercise tolerance, expressed as heart rate threshold (p < 0.001).
The standardized exam was feasible and useful in assisting the clinician in prescribing effective rehabilitation. The 6-week customized rehabilitation program demonstrated significant changes in patient-reported persistent post-concussion symptoms and exercise tolerance. The implementation of a customized program based on a standardized exam performed to subgroup the ostensible symptom generators may be key to successful management in this population.
即使是经验最丰富的慢性疼痛专家，管理脑震荡后综合征也是一项具有挑战性的工作。患者的表现具有异质性，症状涵盖身体、认知和情感领域。所报告的症状通常不具有特异性，这使得医疗专业人员难以开出有效的康复方案。本研究的目的是在对患有脑震荡后综合征的成年人进行标准化临床检查后，根据亚组确定情况来检验定制康复计划的有效性。
共有16名患有脑震荡后综合征的成年人（平均年龄±标准差，38.3±12.5岁）参加了为期6周的康复计划。参与者从加拿大多伦多地区周边的外部社区脑震荡诊所招募。参与者接受了全面的标准化临床检查，以将表面症状产生源分为自主神经、颈部或前庭眼动亚组。然后根据他们的亚组分类开出定制的康复方案。主要结局指标是里弗米德脑震荡后问卷（RPQ）。次要结局指标包括患者健康问卷-9（PHQ-9）、颈部功能障碍指数（NDI），以及通过布法罗脑震荡跑步机测试（BCTT）评估的运动耐量。
经过6周的定制康复后，参与者在RPQ-3和RPQ-13方面平均经历了显著且具有临床意义的变化（p<0.001）。我们还观察到所有次要结局指标都有显著变化，包括PHQ-9降低（p<0.01）、NDI降低（p<0.001）以及以心率阈值表示的运动耐量降低（p<0.001）。
标准化检查在协助临床医生开出有效康复方案方面是可行且有用的。为期6周的定制康复计划在患者报告的持续性脑震荡后症状和运动耐量方面显示出显著变化。基于对表面症状产生源进行亚组分类的标准化检查实施定制计划可能是该人群成功管理中的关键。
