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Rest and treatment/rehabilitation following sport-related concussion: a systematic review
  1. Kathryn J Schneider1,
  2. John J Leddy2,
  3. Kevin M Guskiewicz3,
  4. Tad Seifert4,
  5. Michael McCrea5,
  6. Noah D Silverberg6,
  7. Nina Feddermann-Demont7,8,
  8. Grant L Iverson9,
  9. Alix Hayden10,
  10. Michael Makdissi11,12
  1. 1 Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2 Department of Orthopaedics, SUNY Buffalo, Buffalo, New York, USA
  3. 3 Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4 Norton Healthcare, Louisville, Kentucky, USA
  5. 5 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  6. 6 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7 Department of Neurology, University Hospital Zurich, Zurich, Switzerland
  8. 8 Schulthess Clinic, Zurich, Switzerland
  9. 9 Physical Medicine and Rehabilitation, Harvard Medical School; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
  10. 10 Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
  11. 11 Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
  12. 12 Olympic Park Sports Medicine Centre, Melbourne, Australia
  1. Correspondence to Dr Kathryn J Schneider, Sport Injury Prevention Research Centre, Faculty of Kinesiology University of Calgary, 2500 University Drive N.W. Calgary, Alberta T2N 1N4, Canada; kjschnei{at}


Aim or objective The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

Design Systematic review.

Data sources MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically.

Eligibility criteria for selecting studies Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded.

Results Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care.

Summary/conclusions A brief period (24–48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit.

Systematic review registration PROSPERO 2016:CRD42016039570

  • Concussion
  • mild traumatic brain injury
  • sports
  • rest
  • treatment
  • rehabilitation

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  • Competing interests KS has received speaking honoraria for presentations at scientific meetings. She is a physiotherapy consultant at Evidence Sport and Spinal Therapy in Calgary, Alberta, Canada and for athletic teams. KG is the Founding Director of the Matthew Gfeller Sport-Related TBI Research Center at the University of North Carolina, USA. He is a member of the National Collegiate Athletic Association's Concussion Committee and the US Soccer Federation (unpaid consultant for both). KG at times receives honoraria and reimbursement of expenses to speak at professional meetings. TS is a member of the Speakers Bureau, Avanir Pharmaceuticals. MMC receives research funding from the National Collegiate Athletic Association (NCAA). NS reports a research salary grant from the Vancouver Coastal Health Research Institute, grants and consultant fees from WorkSafeBC, consultant fees from the National Hockey League, receiving salary from the Vancouver Coastal Health Authority and Home Base, a Red Sox Foundation and Massachusetts General Hospital programme, outside the submitted work. GI has been reimbursed by the government, professional scientific bodies and commercial organisations for discussing or presenting research relating to MTBI and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including athletes). He receives support from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation and ImPACT Applications, Inc. MM is a consultant Sport and Exercise Medicine physician at Olympic Park Sports Medicine Centre and team physician for the Hawthorn football club (Australian Football League, AFL). He receives research funding from the Australian Football League (AFL) and non-financial support from CogState Pty Ltd. He has attended meetings organised by the IOC, National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. He is an honorary member of concussion working/advisory groups for AFL, Australian Rugby Union and World Rugby.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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