Article Text

Download PDFPDF
Safe return to play after protocol-based concussion management by a team therapist: a prospective study
  1. Pierre Frémont1,2,
  2. Édith Castonguay2,
  3. Francesco Pepe-Esposito3,
  4. Vincent Beaudoin-Hamel2,3,
  5. Catherine Desloges3,
  6. Monika Dionne3,
  7. Marie-Christine Gourde3,
  8. Benoit Hogue3,
  9. Jérémie Lanthier-Plante3,
  10. Maxime Provencher3,
  11. Mikael Quirion3
  1. 1Faculty of Medicine, Laval University, Quebec City, Canada
  2. 2Physiotherapy, Laval University, Quebec City, Canada
  3. 3Académie St-Louis, Laval University, Québec City, Canada


Objective To analyse the safety of a multidisciplinary concussion management protocol where a team therapist is involved in return-to-play (RTP) decisions.

Design Prospective, pre- post-intervention cohort study over 4 seasons of competition

Setting School-based American football program (4 teams; grades 8–12)

Participants: 672 players x year (11–17 year old) for a total of 27741 athlete-exposure.

Intervention A protocol based on the Concussion In Sport Group recommendations was implemented. A computerised neuropsychological (CNP) test was used at baseline and prior to clearance for unrestricted training. For seasons 1–2, the protocol required the team physician to make all RTP decision while defined criteria allowed the team physiotherapist to make the vast majority of the RTP decisions over seasons 3–4.

Outcome measures The primary outcome was the early recurrence (ER) of concussion symptoms following RTP (defined as during the same season).

Results A total of 119 concussions were identified (55 and 64 for the first and last 2 seasons, respectively; incidence rate 4, 3: 1000 athlete-exposures). At the time of the first clearance decision, the CNP test contributed to a negative RTP decision in 67% of cases. During seasons 1–2 no ER was observed. During season 3 one injury unrelated to football resulted in one case of ER prior to clearance and, during season 4, one case of ER occurred during the second game, 11 days after clearance.

Conclusions Safe management of concussions was achieved whether the team physician or the team therapist was responsible for the application of the terms of the protocol.

Competing interests Pierre Frémont chair of the Canadian Concussion Collaborative.

Édith Castonguay is the physiotherapist for the football program described in this study.

Francesco Pepe-Esposito is Head coach of the football program described in this study.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.