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  • 5.13 We cannot translate evidence into clinical practice unless we know how non-pharmacological interventions following concussion are described. A systematic review

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5) Treatment/Rehabilitation
5.13 We cannot translate evidence into clinical practice unless we know how non-pharmacological interventions following concussion are described. A systematic review
  1. Jacqueline van Ierssel1,
  2. Olivia Galea1,2,
  3. Kirsten Holte3,
  4. Caroline Luszawski3,
  5. Elizabeth Jenkins4,
  6. Jennifer O’Neil5,6,
  7. Carolyn Emery3,7,
  8. Rebekah Mannix8,9,
  9. Kathryn Schneider3,7,
  10. Keith Yeates10,11,
  11. Roger Zemek1,12
  1. 1Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
  2. 2School of Physiotherapy, University of Otago, Dunedin, New Zealand
  3. 3Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
  4. 4Faculty of Medicine, University of Ottawa, Ottawa, Canada
  5. 5School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
  6. 6Bruyère Research Institute, Ottawa, Canada
  7. 7Faculty of Kinesiology, University of Calgary, Calgary, Canada
  8. 8Division of Emergency Medicine, Boston Children’s Hospital, Boston, USA
  9. 9Departments of Pediatrics and Emergency Medicine, Harvard University, Boston, USA
  10. 10Department of Psychology, University of Calgary, Calgary, Canada
  11. 11Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Canada
  12. 12Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada

Abstract

Objective Examine how well non-pharmacological interventions are reported following concussion and whether reporting completeness has improved over time.

Design Systematic review.

Data Sources MEDLINE, Embase, PsycInfo, CINAHL, Web of Science up to May 2022.

Eligibility Criteria RCTs in English or French examining non-pharmacological interventions following concussion. We contacted authors to provide unreported information. Two reviewers independently rated reporting completeness using Template for Intervention Description and Replication (TIDieR), Consensus on Exercise Reporting Template (CERT), and international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) checklists. Risk of bias was assessed with the Cochrane RoB- 2 Tool.

Main Results We screened 7456 studies and included 89 RCTs (n=46 high risk-of-bias), representing 9714 participants with concussion. Studies examined 11 different interventions, including sub- symptom threshold aerobic exercise, cervicovestibular therapy, physical and/or cognitive rest, vision therapy, education, psychotherapy, hyperbaric oxygen therapy, transcranial magnetic stimulation, blue light therapy, osteopathic manipulation, and head/neck cooling. The percentage of items completely reported was 80% (95%CI,79.5–80.5) (TIDieR), 83% (95%CI,81.7- 84.3) (CERT), and 81%(95%CI,80.7–81.3) (i-CONTENT). All studies reported TIDieR items 1, Brief name, 4, What procedures, 8, When and how much, and i-CONTENT item 1, Patient selection. The item reported most commonly on the CERT was 14a, Generic or tailored (89%). TIDier items 10, Modifications (33%;95%CI,32.9–33.1) and 11, How well (planned adherence) (42%;95%CI,41.9–42.1) were the least reported. Only CERT reporting completeness increased over 26 years.

Conclusions Non-pharmacological interventions following concussion are moderately-well reported and of high risk-of-bias. Incomplete published description of interventions potentially limits replication of findings and translation of evidence into clinical practice.

https://doi.org/10.1136/bjsports-2023-concussion.278

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