Bishay Anthony E, Jallow Ousman, Jo Jacob, Williams Kristen, Hong Eunyoung, Allen Jackson, Zuckerman Scott L, Terry Douglas P
1Vanderbilt University School of Medicine, Nashville.
2Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.
J Neurosurg Pediatr. 2025 May 9;36(2):173-185. doi: 10.3171/2025.1.PEDS24482. Print 2025 Aug 1.
Return-to-learn (RTL) recommendations and management protocols for athletes after sport-related concussion (SRC) remain heterogeneous. With respect to academics after SRC, the current systematic review evaluated 3 outcome measures in each included study: 1) RTL definition, 2) RTL duration, and 3) factors associated with longer RTL.
Studies published before December 2022 that addressed RTL after an SRC were identified via a compressive literature search of the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed databases. Studies solely examining nonsport-related concussion/traumatic brain injury studies were excluded. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the Modified Newcastle-Ottawa Scale for risk of bias. For each study included, the design, participants, interventions, outcomes, results, and conclusions were extracted.
Of 1838 studies identified, 21 met the inclusion criteria. These studies represented 8475 athletes (aged 5-27 years) who sustained an SRC. A total of 17/21 (81%) provided an RTL definition. Of the studies that defined RTL as any RTL, the median (range) was 5 (2.5-35.3) days, while the median (range) of those that defined RTL as full RTL without accommodations was 17.5 (3-49) days. Female gender (7/9 studies) and initial symptom severity (3/3 studies) were consistently associated with delayed RTL. Single studies identified anxiety, attention-deficit/hyperactivity disorder (ADHD), and integrated performance management as potential factors for delayed RTL. Age (0/5 studies), concussion history (2/6), depression history (0/1), migraine history (0/2), learning disability (0/1), school type (public vs private) (0/2), and early air travel after SRC (0/1) did not appear to have consistent effects on RTL.
Across 21 primary studies, RTL definitions varied greatly, and similarly, a wide range of days to RTL was seen at 3-35 days. Female gender and initial symptom severity were most consistently associated with prolonged RTL. Certain factors such as a history of ADHD/anxiety showed potential effects but require further investigation. Management guidelines should consider these findings while recognizing the need for more comprehensive research to confirm and quantify the impact of various factors on RTL duration.
运动相关脑震荡（SRC）后运动员的复学（RTL）建议和管理方案仍然存在差异。关于SRC后的学业情况，当前的系统评价在每项纳入研究中评估了3项结果指标：1）RTL的定义，2）RTL持续时间，以及3）与较长RTL相关的因素。
通过对Cochrane对照试验中央注册库、CINAHL、SPORTDiscus、教育资源信息中心、Ovid MEDLINE和PubMed数据库进行全面的文献检索，确定2022年12月之前发表的关于SRC后RTL的研究。仅研究非运动相关脑震荡/创伤性脑损伤的研究被排除。使用牛津循证医学中心标准和改良的纽卡斯尔-渥太华偏倚风险量表评估研究质量。对于每项纳入研究，提取其设计、参与者、干预措施、结果、结果和结论。
在1838项识别出的研究中，21项符合纳入标准。这些研究涵盖了8475名发生SRC的运动员（年龄在5 - 27岁之间）。共有17/21（81%）提供了RTL的定义。在将RTL定义为任何复学情况的研究中，中位数（范围）为5（2.5 - 35.3）天，而将RTL定义为无特殊安排的完全复学的研究中，中位数（范围）为17.5（3 - 49）天。女性（7/9项研究）和初始症状严重程度（3/3项研究）始终与延迟复学相关。单项研究确定焦虑、注意力缺陷多动障碍（ADHD）和综合绩效管理是延迟复学的潜在因素。年龄（0/5项研究）、脑震荡史（2/6）、抑郁史（0/1）、偏头痛史（0/2）、学习障碍（0/1）、学校类型（公立与私立）（0/2）以及SRC后早期航空旅行（0/1）似乎对RTL没有一致的影响。
在21项主要研究中，RTL的定义差异很大，同样，复学所需天数在3 - 35天之间也有很大差异。女性和初始症状严重程度与延长的RTL最一致相关。某些因素，如ADHD/焦虑史，显示出潜在影响，但需要进一步研究。管理指南在认识到需要更全面的研究来确认和量化各种因素对RTL持续时间的影响的同时，应考虑这些发现。
