Articles examining strategies or provision/receipt of accommodations on return to school
Article | Study design, duration, country | Participants (n, age, sex) | Exposure/intervention (Definition) | Outcome (Definition) | Results (including statistical outcomes) | Main limitations | Study quality assessment (DB score) | Level of evidence |
Carson et al 34 | Retrospective EMR review April 2006 to March 2011 Canada | n=159 elementary (24.1%), secondary (55.9%), college/university (20.0%) Ages not specified 170 concussions 61.8% male | SRC student-athletes assessed by same family and sport medicine physician who gave advice regarding cognitive and physical rest after concussion | Premature RTP/RTL defined as recurrence or worsening of symptoms on RTL or RTP using SCAT and self-report | Symptom recurrence with RTP=43.5% and RTL=44.7% Prior concussion associated with more rest days before return to activity (RTA) (P<0.001) Elementary school patients required fewer rest days to RTA (11.6 days) versus high school (25.1) versus college/university (23.6) (P=0.0163) |
| 17 | 4 |
Corwin et al 35 | Retrospective EMR review July 2010 to December 2011 USA | Convenience sample (n=247 selected from 3740) (same data set as ref 24) Median age 14 (7–18) years 58% male | Patients with concussion seen at a tertiary paediatric hospital-affiliated Sports Medicine Clinic | Identify pre-existing characteristics associated with prolonged recovery |
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| 18 | 4 |
Glang et al 36 | RCT August to November 2011 USA (knowledge transfer) | High schools in Oregon (n=25) (13 intervention, 12 control) |
Brain 101 website (intervention), CDC material on safety (not concussion)
| Effect on parents and athletes’ concussion knowledge, behavioural intention and concussion management |
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| 19 | 2 |
Grubenhoff et al 37 | Secondary analysis of a prospective longitudinal cohort observational study October 2010 to March 2013 USA | n=234 Aged 8–18 years enrolled, 179 completed follow-up 70% male (no PPCS) 66% male (PPCS) | Concussed patients seen in urban ED with and without prolonged symptoms (≥3 new symptoms >1 month after injury) | Number of follow-up visits after ED visit; number of school days missed; receipt of academic accommodations |
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| 20 | 4 |
Thomas et al 38 | Prospective RCT Urban paediatric ED May 2010 to December 2012 USA | n=99 11–22 years of age (median 13.7 years) One-third female 71% SRC | Concussed patients randomised to strict rest (intervention) versus usual care (control)
| Concussion recovery and outcome |
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| 21 | 2 |
Zuckerbraun et al 39 | Preimplementation and postimplementation design in 2 urban paediatric EDs Pre-February to July 2009 Post-December 2009 to June 2010 USA | 164 participants pre 190 participants post Mean age 10.6 years (SD 3.7) 65% male 27% SRC | Use of modified ACE tools in concussed patients | Impact of ACE-ED tools on patient follow-up and postinjury behaviour | After implementation, 58% of patients received ACE-ED and 84% received ACE-ED DI
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| 20 | 3 |
ACE-ED, Acute Concussion Evaluation-Emergency Department; ACE-ED DI, Acute Concussion Evaluation-Emergency Department Discharge Instruction; CMT, concussion management team; CDC, Centers for Disease Control; DB, Downs and Black checklist; ED, emergency department; EMR, electronic medical record; PCS, postconcussion symptoms; PCSS, Post-Concussion Symptom Score; PPCS, persistent postconcussive symptoms; RCT, randomised controlled trial; RTA, return to activity; RTL, return to learn; RTP, return to play; RTS, return to school; SCAT, Sports Concussion Assessment Tool; SRC, sport-related concussion.