Physical activity interventions may improve symptom resolution in children following concussion

1. In a systematic review and meta-analysis of interventions following concussion in children, engaging in physical activity had a significant effect on concussion symptom reporting.

2. Engagement in physical activity following concussion did not have any significant effect on reported quality of life.

Evidence Rating Level: 2 (Good)

Study Rundown: Concussions are common in children and symptoms following the initial injury are often prolonged compared to those in adults. Although guidelines currently recommend early return to activity following concussion based on several individual studies, meta-analyses of this data are lacking. This study sought to determine the impact of physical activity and social activity on youth recovering from concussions through a systematic review and meta-analyses. A total of 24 articles were included, 10 of which were randomized controlled trials (RCTs). All 24 studies included some element of physical activity in their interventions, most commonly aerobic exercise. Most studies were conducted in a clinic setting, but some studies used at-home or other non-clinic exercise programs. A meta-analysis of 7 RCTs found that physical activity had a significant effect on symptom reporting (duration, severity, and number of symptoms). A meta-analysis of two RCTs measuring quality of life (QoL) demonstrated that engagement in activity did not have a significant effect on QoL. Though the results of this study suggest that physical exercise may have a positive impact on symptom resolution, the heterogeneity of the interventions in the included studies (e.g., some studies began the intervention within days after injury while others started the intervention years later), and the risk of bias due to self-reporting questionnaires and inability to blind are major limitations. Finally, due to a lack of RCTs available, a meta-analysis could not be performed to assess the important outcome of return to preinjury activity levels. Overall, the results of this meta-analysis support the current clinical guidelines in their recommendation to engage in early physical activity following concussion in children.

Click to read the study in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant Reading: Effect of Exercise Recommendation on Adolescents With Concussion

In-Depth [systematic review and meta-analysis]: 24 studies were included in the systematic review, assessing symptom resolution, quality of life, and length of time to pre-concussion activity levels, following concussion injuries. Sample sizes ranged from 6 to 677, and 4 of 24 studies included some adult population. Studies were included if over 50% of the individuals were under age 18. Using the Cochrane risk-of-bias tool, most of the RCTs had a high risk of bias. Using the ROBINS-I tool for non-randomized trials, most of the non-RCT studies had a moderate risk of bias. The meta-analysis examining the effect of physical activity on symptom resolution using 7 RCTs showed a significant effect with a standardized mean difference of 0.39 (95% CI 0.15-0.62, p=0.002). The meta-analysis conducted on 2 RCTs measuring the effect of physical exercise on QoL showed no significant effect on QoL with a mean difference of -0.91 (95% CI -7.76-5.94, P=0.79). Return to pre-injury levels of physical activity was measured in 5 studies, 4 of which measured the number of days from injury to full return of play. 50% of those studies found a significant reduction in the number of days to return to activity following the exercise interventions, while 50% observed no significant effect. The 1 RCT examining this outcome showed no significant results between the control group and the exercise intervention group (P=0.82).

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