This systematic review aimed to investigate the effects of physical therapy interventions compared to alternative treatments in adolescent and young adult athletes post-concussion.
Articles were included if they were randomized controlled-trials, had participants who were athletes under the age of thirty who had an acute or chronic sport-related concussion, and the intervention was physical therapy, including aerobic and multimodal interventions. Six databases were searched between March 2021 and January 2022. The PEDro scale was used to assess methodological quality of included trials to indicate high (>5/10), moderate (5/10) and low (<5/10) quality.
Eight articles were included in the review. Four assessed aerobic intervention and four assessed multimodal intervention. Multimodal treatment included individualised exercise progression, early intervention, cervical spine and vestibular rehabilitation, asymptomatic exercise and visualisation and imagery. Control treatment included stretching, education, subtherapeutic exercise, range of motion exercise, visualisation, rest and delayed intervention.
The outcome measures included the days from injury to recovery, PCSS, PCSI, Health Related Quality of Life, Beck Depression Inventory for Youth, Pediatric Quality of Life Multidimensional Fatigue Scale, the BESS, ImPACT, time to return to play, health and demographic questionnaires, Borg CR10, Rate of Perceived Exertion (RPE), and Post Ride Symptom Change Rating. The control groups either participated in education, rest, sub-therapeutic exercise, placebo, or sham treatment. None of the studies demonstrated any significant adverse effects from early physical activity and physical therapy intervention.
375 athletes (163 females and 212 males) participated in the eight studies with ages ranging from 11.2 to 21.2 years. The severity of symptoms ranged from acute post-concussion symptoms to chronic post-concussion symptoms. One article did not indicate the severity of concussion. Participants had either one concussion or a recurrence of concussions. Two articles did not indicate the occurrence of concussion.
Five of the eight articles were of a higher quality relating to risk of bias compared to the other three included articles, with scores ranging from a 5 to a 10 out of 10 points although there is no indication that the assessor had undertaken PEDro reviewer training.
Three of the five higher-quality articles found significant improvements in the treatment groups compared to the control groups with reduction in symptoms and time to recovery. All articles demonstrated improved symptoms with time and no notable adverse effects were reported with early physical activity and therapy. Due to the variability in the types of intervention utilised and the subjects on whom the interventions and controls were performed, the study was unable to determine the optimal treatment intervention.
This systematic review suggests that aerobic exercise or multi-modal interventions may lead to quicker recovery and return to sport in adolescent and young adult athletes with post-concussive symptoms when compared to traditional treatments such as physical and cognitive rest.
Art K, Ridenour C, Durbin S, Bauer M, Hassen-Miller A. The Effectiveness of Physical Therapy Interventions for Athletes Post-Concussion: A Systematic Review. Int J Sports Phys Ther. 2023 Feb 1;18(1):26-38. doi: 10.26603/001c.68071.
