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Compliance with and effectiveness of return-to-activity progressions following concussion: a systematic review of the literature
  1. Tamara C Valovich McLeod,
  2. Joy H Lewis,
  3. Kate Whelihan,
  4. Cailee E Welch Bacon
  1. School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA


Objective To systematically review the literature regarding healthcare provider compliance with and the effectiveness of the graded return-to-activity progression.

Design Systematic Review.

Search strategy An electronic search was conducted in 6 databases. Search terms included: brain concussion AND-rest; concuss*AND-sports-AND-rest, -sports-AND-return-to-play; mild traumatic brain injury AND-return-to-activity, -return-to-play; recurrent concussion-AND-sport. Hand searches were also performed.

Study selection After removal of duplicates, initial screen of titles and abstracts was completed by 3 authors, followed by full text review. Articles were included if they were in English and original studies related to the clinical questions. Reviews, editorials, commentaries, and animal research were excluded.

Data extraction The initial search yielded 2851 articles, with 1239 undergoing title/abstract screen, 143 undergoing full-text review, and 21 included in the review. Study design, patient/participant, instrumentation/interventions utilised, outcome measures, main results, and conclusions were extracted. Strength of recommendation (SOR) as outlined by the Oxford Centre for Evidence-Based Medicine was assigned to the body of literature.

Data synthesis Articles were categorised based on their ability to answer one of the clinical questions of interest and the conclusions were summarised using a qualitative synthesis of the findings. Data were not appropriate for meta-analysis due to the observational nature of many included studies and heterogeneity of the patients, participants, interventions and outcomes.

Conclusions The review identified that significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists (SOR=B) and there is little evidence to support the effectiveness of the graded return-to-activity progression (SOR=D).

Competing interests None.

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