1. Individuals with concussions with persistent symptoms were three times more likely to return to sport by 8 weeks if they received presentation-specific multimodal interventions.
2. In comparison to controls, multimodal interventions had a moderate effect in improving concussion symptom scores.
Evidence Rating Level: 1 (Excellent)
Concussions are a common injury that are known to be under-reported and undermanaged. Current recommendations suggest 24-48 hours of cognitive and physical rest followed by a stepwise return to physical activity. However, with emerging evidence for the incorporation of physical interventions such as subthreshold aerobic exercise, cervical therapy, vestibular and/or oculomotor rehabilitation, management may ultimately change. Therefore, the objective of the present systematic review and meta-analysis was to synthesize the available evidence and determine the influence of these physical interventions on acute and ongoing symptoms of concussion.
From 2977 identified articles,12 trials (647 participants) were included from database inception to September 2020. Studies were eligible if they examined the effect of subthreshold aerobic exercise, cervical therapy, vestibular therapy or oculomotor therapy on recovery following concussion (either acute or ongoing, from any cause). Studies that were not in English or were published in abstract form were excluded. The quality of the studies was found to be fair to excellent according to the PEDro scale.
The results of this study found that concussed individuals with persistent (>2 week) symptoms who received tailored multimodal interventions sustained a reduction in symptoms and were three times more likely to return to sports by 8 weeks. Furthermore, multimodal interventions were shown to have a moderate effect on improving concussion symptom scores compared to control. This study was limited by the small number of studies for certain interventions, which could have led to a bias in the results. However, this study identified 6 new randomized controlled trials of fair to excellent quality since the prior systematic review which has added additional evidence to support the use of physical interventions in the management of concussion symptoms.
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