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Advances in concussion management
Cervico-vestibular physiotherapy in the treatment of individuals with persistent symptoms following sport related concussion: a randomised controlled trial
  1. Kathryn J Schneider1,*,
  2. Willem H Meeuwisse1,
  3. Alberto Nettel-Aguirre2,3,
  4. Lara Boyd4,
  5. Karen M Barlow5,
  6. Carolyn A Emery1,3,6
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  4. 4Brain Research Centre, UBC Hospital, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Department of Pediatrics and Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  6. 6Department of Pediatrics, Alberta Children's Hospital Research Institute for Child and Maternal Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

    Abstract

    Objective The objective of this study was to determine if a combination of cervical and vestibular physiotherapy is an effective treatment for individuals with persistent symptoms following a sport related concussion (SRC).

    Design Randomised Controlled Trial.

    Subjects Thirty-one participants (12–30 years) who attended the University of Calgary Sport Medicine Centre for a SRC and had persistent symptoms of dizziness, neck pain and/or headaches.

    Intervention Participants were randomly allocated to a treatment group (ie, multimodal physiotherapy including vestibular rehabilitation, manual therapy, neuromotor and sensorimotor retraining exercises) or a control group (ie, rest followed by gradual exertion). Participants in both groups were seen by the study treating physiotherapist once weekly for 8 weeks or until the time of medical clearance. A sport medicine physician who was blinded to treatment group determined time to medical clearance.

    Outcome Measurements The primary outcome of interest was medical clearance to return to sport.

    Results One of 14 subjects (7.1%) in the control group and 11 of 15 subjects (73.3%) in the treatment group were medically cleared to return to sport at 8 weeks. The participants in the treatment group were 10.27 (95% CI 1.51 to 69.55) times more likely to be medically cleared to return to sport in 8 weeks than the participants in the control group (p<0.001).

    Conclusions Participants who received multimodal physiotherapy treatment were more likely to achieve medical clearance before 8 weeks when compared with rest in individuals with persistent symptoms following an SRC.

    Acknowledgements The Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. This study was funded by an Investigator Driven Small Grant from the Alberta Centre for Child, Family and Community Research. Kathryn Schneider is supported by a studentship through Alberta Innovates Health Solutions (AIHS) and Carolyn Emery by AIHS and Alberta Children's Hospital Research Institute.

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