TY - JOUR T1 - Is early activity resumption after paediatric concussion safe and does it reduce symptom burden at 2 weeks post injury? The Pediatric Concussion Assessment of Rest and Exertion (PedCARE) multicentre randomised clinical trial JF - British Journal of Sports Medicine JO - Br J Sports Med SP - 271 LP - 278 DO - 10.1136/bjsports-2021-105030 VL - 56 IS - 5 AU - Andrée-Anne Ledoux AU - Nick Barrowman AU - Vid Bijelić AU - Michael M Borghese AU - Adrienne Davis AU - Sarah Reid AU - Gurinder Sangha AU - Keith Owen Yeates AU - Mark S Tremblay AU - Candice McGahern AU - Kevin Belanger AU - Joel D Barnes AU - Ken J Farion AU - Carol A DeMatteo AU - Nick Reed AU - Roger Zemek A2 - , Y1 - 2022/03/01 UR - http://bjsm.bmj.com/content/56/5/271.abstract N2 - Objective Investigate whether resuming physical activity (PA) at 72 hours post concussion is safe and reduces symptoms at 2 weeks, compared with resting until asymptomatic.Methods Real-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian paediatric emergency departments (ED). Children/youth aged 10–<18 years with acute concussion were recruited between March 2017 and December 2019, and randomly assigned to a 4-week stepwise return-to-PA protocol at 72 hours post concussion even if symptomatic (experimental group (EG)) or to a return-to-PA once asymptomatic protocol (control group (CG)). The primary outcome was self-reported symptoms at 2 weeks using the Health and Behaviour Inventory. Adherence was measured using accelerometers worn 24 hours/day for 14 days post injury. Adverse events (AE) (worsening of symptoms requiring unscheduled ED or primary care visit) were monitored. Multivariable intention-to-treat (ITT) and per-protocol analyses adjusting for prognostically important covariates were examined. Missing data were imputed for the ITT analysis.Results 456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2 weeks (adjusted mean difference=−1.3 (95% CI:−3.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2 weeks post injury, compared with rest (adjusted mean difference=−4.3 (95% CI:−8.4 to –0.2)).Conclusion Symptoms at 2 weeks did not differ significantly between children/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2 weeks. Resumption of PA is safe and may be associated with milder symptoms at 2 weeks.Level of evidence 1b.Trial registration number NCT02893969.Registry name Pediatric Concussion Assessment of Rest and Exertion (PedCARE).Data are available upon reasonable request. The data that support the findings of this study are available on reasonable request from the corresponding author in accordance to ethical and legal regulations regarding the sharing of information as to prevent compromising the privacy of research participants. ER -