@article {GagnonA87, author = {Isabelle Gagnon and Danielle M. Dobney CAT (C) and Lisa Grilli MSc PT and Helen Kocilowicz and Christine Beaulieu and Meghan Straub and Debbie Friedman}, title = {When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents}, volume = {51}, number = {11}, pages = {A87--A87}, year = {2017}, doi = {10.1136/bjsports-2016-097270.225}, publisher = {British Association of Sport and Excercise Medicine}, abstract = {Objective Estimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.Design Retrospective analysis of a prospective cohortSetting Concussion clinic of a tertiary care Paediatric Trauma Centre in Canada.Participants 569 youth (14.3{\textpm}2.3 years) with persistent PCS. Clinic patients{\textquoteright} information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.Intervention Active rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).Outcome measure Symptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p\<0.05).Conclusions The findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.Competing interests None.}, issn = {0306-3674}, URL = {https://bjsm.bmj.com/content/51/11/A87.2}, eprint = {https://bjsm.bmj.com/content/51/11/A87.2.full.pdf}, journal = {British Journal of Sports Medicine} }