Article Text

Download PDFPDF

Cervicovestibular rehabilitation following sport-related concussion
  1. Kathryn J Schneider1,2,3,
  2. Willem H Meeuwisse1,3,
  3. Karen M Barlow2,3,
  4. Carolyn A Emery1,2,3,4,5
  1. 1 Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
  2. 2 Alberta Children’s Hospital Research Institute for Child and Maternal Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5 Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Kathryn J Schneider, Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB T2N 1N4, Canada; kjschnei{at}ucalgary.ca

Statistics from Altmetric.com

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.

Dizziness, neck pain and headaches are commonly reported following a sport-related concussion and may persist.1 2 A combination of cervical and vestibular physiotherapy facilitates recovery following sport-related concussion in individuals with ongoing symptoms of dizziness, neck pain and headaches.3 In our randomised controlled trial (RCT), a higher proportion of individuals treated with multimodal physiotherapy were reported to be medically cleared to return to sport (within 8 weeks) than that of individuals who received a control intervention.4 However, the effect of timing of treatment is not currently known.

Here we share the results of the second phase of this RCT, which evaluated the efficacy of multimodal physiotherapy and vestibular rehabilitation compared with rest in individuals with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion. Individuals who had already completed an 8-week period of either multimodal physiotherapy intervention or control intervention and had not recovered (as defined by medical clearance to return to sport) are the subject of this study.

Eleven of 31 individuals who participated in an initial RCT and were not medically cleared to return to sport after 8 weeks of treatment were given the opportunity to participate in the other study group (to which they had not been randomised, ie, monitored crossover). In this portion of the study, the multimodal physiotherapy intervention group (n=9 who previously participated in the control group in the initial phase of the trial) received a combination of cervical and vestibular physiotherapy treatment and the control intervention group (n=2 who previously participated in the intervention group in the initial phase of the trial) completed a protocol of rest followed by graded exertion. The methods used in this portion of the study were identical to the initial phase of the study.4 The primary outcome was medical clearance to return to play (RTP) at 8 weeks following initiation of treatment.

Three of nine (33%) individuals crossing from the control to the multimodal physiotherapy intervention group were medically cleared by 8 weeks, compared with no participants in the control group. If clearance for commencement of the protocol of graded exertion rather than RTP was selected as the end point, then seven of nine participants would have been performing a protocol of graded exertion in the treatment group (78%) compared with one of two individuals in the control group (50%).

In summary, we acknowledge that the individuals who were less likely to respond to treatment may have been the individuals who chose to continue with a second phase of treatment. Although there was a large amount of variability in the baseline measures, it appears that the individuals who chose to participate in this portion of the trial may have had more severe neck pain, dizziness and headaches than those who did (see table 1). Thus, it is possible that the group of individuals who chose to participate represented a more severe sample and thus may be less likely to respond to treatment, resulting in an underestimate of the effect of treatment in this patient population. There may also be an effect of time since injury on treatment outcome, with early treatment resulting in more positive results.

Table 1

Initial participant characteristics for second phase of RCT

Acknowledgments

The authors would like to acknowledge the clinical assistance of Dr Brian Benson and Nancy Fletcher MacCormack in the clinical assessment, follow-up and data collection for this study.

References

Footnotes

  • Contributors KJS, WHM and CAE contributed to the planning, conduct of analysis, interpretation and reporting of results. KMB contributed to the planning and reporting of results. All authors critically reviewed the final version of the research letter.

  • Funding This study was funded by the Alberta Centre for Child, Family and Community Research (equipment and physiotherapist assessment consultations). KJS was supported by an Alberta Heritage Foundation for Medical Research studentship award at the time of this work. CAE was funded by a chair in paediatric rehabilitation funded by the Children’s Hospital Foundation (Alberta Children’s Hospital Research Institute for Child and Maternal Health). 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.

  • Competing interests None declared.

  • Ethics approval Conjoint Health Research Ethics Board, University of Calgary.

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