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Langevin P, Frémont P, Fait P, Dubé MO, Roy JS. Moving from the clinic to telehealth during the COVID-19 pandemic - a pilot clinical trial comparing in-clinic rehabilitation versus telerehabilitation for persisting symptoms following a mild Traumatic brain injury. Disabil Rehabil 2024; 46:2880-2889. [PMID: 37466379 DOI: 10.1080/09638288.2023.2236016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS). MATERIALS AND METHODS DESIGN In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic (n = 30) or telerehabilitation (n = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used. RESULTS For the PCSS, there was a group-by-time interaction (p = 0.05) with significant between-group differences at week 6, 12, and 26 (p < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache (p < 0.05) for the in-clinic group. CONCLUSION The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661.IMPLICATION FOR REHABILITATIONThe telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Philippe Fait
- Clinique Cortex and Physio Interactive, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
- Department of Human Kinetics, University of Quebec at Trois-Rivières, Trois-Rivières, Canada
- Research Center in Neuropsychology and Cognition (CERNEC), Montréal, Canada'
| | - Marc-Olivier Dubé
- Clinique Cortex and Physio Interactive, Québec, Canada
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute (CIRRIS), Quebec City, Canada
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McPherson JI, Kaur G, Darling SR, Surace A, Willer BS, Leddy JJ, Haider MN. Early Identification and Management of Cervical Impairments in Pediatric Patients With Concussion May Reduce Risk of Delayed Recovery. Clin J Sport Med 2024; 34:25-29. [PMID: 37462603 DOI: 10.1097/jsm.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/22/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Previous research, including high-quality systematic reviews, has found that cervical injury, which often accompanies concussive head injury, can delay recovery from concussion. One pilot randomized controlled trial found that focused cervical assessment and appropriate intervention in children and young adults with persisting postconcussive symptoms (PPCS) improved recovery outcomes. Our sports medicine clinics adopted this approach early (within 2 weeks) in children (aged 10-18 years) after concussion. This study describes our clinical management protocol and compares the recovery trajectories in children after concussion with and without a concomitant cervical injury. DESIGN Prospective cohort study. SETTING Three university-affiliated outpatient sports medicine clinics from September 2016 to December 2019. PATIENTS One-hundred thirty-four concussed children with cervical impairment (mean age 14.9 years, 65% male, and 6.2 days since concussion) were compared with 130 concussed children without cervical impairment (mean age 14.9 years, 57% male, and 6.0 days since concussion). INDEPENDENT VARIABLES Examination findings related to the cervical spine (range of motion, cervical spasm, and cervical tenderness). MAIN OUTCOME MEASURES Recovery time (measured in days), concussion symptom burden (Postconcussion Symptom Scale), and incidence of PPCS. RESULTS Children with cervical impairment reported a higher initial symptom burden; however, there were no differences in recovery time (33.65 [28.20-39.09] days vs 35.98 [27.50-44.45] days, P = 0.651) or incidence of PPCS (40.0% vs 34.3%, P = 0.340). CONCLUSIONS We conclude that within this pediatric population, early identification and management of cervical injuries concomitant with concussion may reduce the risk of delayed recovery.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | - Gurleen Kaur
- Department of Biological Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Scott R Darling
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Anthony Surace
- Niagara Falls Memorial Medical Center, Niagara Falls, New York
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York; and
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Mohammad N Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Oyekan AA, Eagle S, Trbovich AM, Shaw JD, Schneider M, Collins M, Lee JY, Kontos AP. Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion. J Head Trauma Rehabil 2023; 38:417-424. [PMID: 36854136 PMCID: PMC10619635 DOI: 10.1097/htr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To examine the frequency and association of neck pain symptoms in patients with a concussion. STUDY SETTING AND PARTICIPANTS Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. DESIGN Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. RESULTS Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. CONCLUSION Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
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Affiliation(s)
- Anthony A Oyekan
- Departments of Orthopaedic Surgery (Drs Oyekan, Trbovich, Shaw, Collins, Lee, and Kontos) and Physical Therapy (Dr Schneider), University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Ortho Spine Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Oyekan, Shaw, and Lee); Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Eagle); and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Trbovich, Collins, and Kontos)
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McPherson JI, Haider MN, Miyashita T, Bromley L, Mazur B, Willer B, Leddy J. Adults are not older adolescents: comparing physical therapy findings among adolescents, young adults and older adults with persistent post-concussive symptoms. Brain Inj 2023; 37:628-634. [PMID: 36882904 DOI: 10.1080/02699052.2023.2187091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Individuals with persistent post-concussive symptoms (PPCS) may present with a myriad of physical symptoms. There is limited research available comparing the presence of examination findings among individuals with PPCS from different age groups. METHODS Retrospective case-control chart review of 481 patients with PPCS and 271 non-trauma controls. Physical assessments were categorized as ocular, cervical, and vestibular/balance. Differences in presentation were compared between PPCS and controls as well as between individuals with PPCS in three age groups: adolescents, young adults, and older adults. RESULTS All three PPCS groups had more abnormal oculomotor findings than their age-matched counterparts. When comparing PPCS patients from different age groups, no differences were seen in prevalence of abnormal smooth pursuits or saccades; however, adolescents with PPCS had more abnormal cervical findings and a lower prevalence of abnormal NPC, vestibular and balance findings. CONCLUSION Patients with PPCS presented with a different constellation of clinical findings based on their age. Adolescents were more likely to demonstrate evidence of cervical injury compared to younger and older adults, and adults were more likely to present with vestibular findings and impaired NPC. Adults with PPCS were more likely to present with abnormal oculomotor findings compared to adults with non-traumatic causes of dizziness.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, United States
| | - Mohammad N Haider
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
| | - Theresa Miyashita
- Department of Health & Human Performance, Concordia University-Chicago, River Forest, Illinois, United States
| | - Lacey Bromley
- Department of Physical Therapy, D'Youville University, Buffalo, New York, United States
| | - Benjamin Mazur
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
| | - John Leddy
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States
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Bini P, Hohenschurz-Schmidt D, Masullo V, Pitt D, Draper-Rodi J. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis. Chiropr Man Therap 2022; 30:49. [PMID: 36419164 PMCID: PMC9682850 DOI: 10.1186/s12998-022-00459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cervicogenic headache is a secondary headache, and manual therapy is one of the most common treatment choices for this and other types of headache. Nonetheless, recent guidelines on the management of cervicogenic headache underlined the lack of trials comparing manual and exercise therapy to sham or no-treatment controls. The main objective of this systematic review and meta-analysis was to assess the effectiveness of different forms of manual and exercise therapy in people living with cervicogenic headache, when compared to other treatments, sham, or no treatment controls. METHODS Following the PRISMA guidelines, the literature search was conducted until January 2022 on MEDLINE, CENTRAL, DOAJ, and PEDro. Randomized controlled trials assessing the effects of manual or exercise therapy on patients with cervicogenic headache with headache intensity or frequency as primary outcome measures were included. Study selection, data extraction and Risk of Bias (RoB) assessment were done in duplicate. GRADE was used to assess the quality of the evidence. RESULTS Twenty studies were included in the review, with a total of 1439 patients. Common interventions were spinal manipulation, trigger point therapy, spinal mobilization, scapulo-thoracic and cranio-cervical exercises. Meta-analysis was only possible for six manual therapy trials with sham comparators. Data pooling showed moderate-to-large effects in favour of manual therapy for headache frequency and intensity at short-term, small-to-moderate for disability at short-term, small-to-moderate for headache intensity and small for headache frequency at long-term. A sensitivity meta-analysis of low-RoB trials showed small effects in favor of manual therapy in reducing headache intensity, frequency and disability at short and long-term. Both trials included in the sensitivity meta-analysis studied spinal manipulation as the intervention of interest. GRADE assessment showed moderate quality of evidence. CONCLUSION The evidence suggests that manual and exercise therapy may reduce headache intensity, frequency and disability at short and long-term in people living with cervicogenic headache, but the overall RoB in most included trials was high. However, a sensitivity meta-analysis on low-RoB trials showed moderate-quality evidence supporting the use of spinal manipulation compared to sham interventions. More high-quality trials are necessary to make stronger recommendations, ideally based on methodological recommendations that enhance comparability between studies. Trial registration The protocol for this meta-analysis was pre-registered on PROSPERO under the registration number CRD42021249277.
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Affiliation(s)
- Pietro Bini
- University College of Osteopathy, 275 Borough High Street, London, SE1 1JE, UK.
| | - David Hohenschurz-Schmidt
- grid.439369.20000 0004 0392 0021Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, Chelsea and Westminster Hospital, 4Th Floor, 369 Fulham Road, London, SW10 9NH UK
| | - Vincenzo Masullo
- grid.468695.00000 0004 0395 028XUniversity College of Osteopathy, 275 Borough High Street, London, SE1 1JE UK
| | - Diana Pitt
- grid.418582.20000 0000 9499 3744Department of Applied Social Science and Social Practice, Ara Institute of Canterbury, Madras Campus, “O” Building, Madras street, Christchurch Central City, Christchurch, 8011 New Zealand
| | - Jerry Draper-Rodi
- grid.468695.00000 0004 0395 028XUniversity College of Osteopathy, 275 Borough High Street, London, SE1 1JE UK
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Langevin P, Frémont P, Fait P, Roy JS. Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthop J Sports Med 2022; 10:23259671221127049. [PMID: 36250029 PMCID: PMC9561659 DOI: 10.1177/23259671221127049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined. Purpose To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and Numeric Pain Rating Scale (NPRS) related to 1) neck pain and 2) headache. Internal responsiveness was evaluated using the effect size (ES) and standardized response mean (SRM), and external responsiveness was determined with the minimal clinically important difference (MCID) calculated using a receiver operating characteristic curve. The global rating of change was used as the external criterion. Pearson correlations were used to determine the longitudinal validity. Results The PCSS was highly responsive (ES and SRM, >1.3) and had an MCID of 26.5 points (of 132) for the total score and 5.5 (of 22) for the number of symptoms. For longitudinal validity, low to moderate correlations were found between changes in PCSS and changes in NDI, HDI, and DHI. The NDI, HDI, DHI, and NPRS were also highly responsive (ES and SRM, >0.8). Conclusion All questionnaires including the PCSS were highly responsive and can be used with confidence by clinicians and researchers to evaluate change over time in a concussion population with persistent symptoms.
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Affiliation(s)
- Pierre Langevin
- Clinique Cortex and Physio Interactive, Quebec City, Québec,
Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada
| | - Pierre Frémont
- Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada
| | - Philippe Fait
- Clinique Cortex and Physio Interactive, Quebec City, Québec,
Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada.,Department of Human Kinetics, Université du Québec à Trois-Rivières,
Quebec City, Québec, Canada.,Research Center in Neuropsychology and Cognition (CERNEC), Montréal,
Québec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval,
Quebec City, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social
Integration (CIRRIS), Québec Rehabilitation Institute, Quebec City, Québec,
Canada.,Jean-Sébastien Roy, PT, PhD, Centre for Interdisciplinary
Research in Rehabilitation and Social Integration, Québec Rehabilitation
Institute, 525, Boulevard Wilfrid Hamel, Quebec City, Québec, Canada, G1M 2S8
()
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Langevin P, Fremont P, Fait P, Dubé MO, Bertrand-Charette M, Roy JS. Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomised Clinical Trial. J Neurotrauma 2022; 39:487-496. [PMID: 35102743 DOI: 10.1089/neu.2021.0508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms following mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomised clinical trial, 60 adults with persistent symptoms following mTBI were randomly assigned to: 1) a 6-week SLAE program or 2) a 6-week cervicovestibular rehabilitation program combined with SLAE program. All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI and return to function, there were no group-by-time interactions at any time-points follow-up (p>0.05); clinically significant time effects were however observed (p0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p0.003) and the cranio-vertebral mobility (p0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function. Keywords: mild traumatic brain injury, rehabilitation, neck pain, dizziness, headache.
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Affiliation(s)
- Pierre Langevin
- Université Laval Faculté de médecine, 12369, Quebec, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Pierre Fremont
- Université Laval, 4440, Department of Rehabilitation, Quebec, Quebec, Canada;
| | - Philippe Fait
- Université du Québec à Trois-Rivières UQTR, Departement of Physical Activity Science, Trois-Rivières, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Marc-Olivier Dubé
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Michael Bertrand-Charette
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
| | - Jean-Sébastien Roy
- Université Laval Faculté de médecine, 12369, Quebec City, Quebec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 560498, Quebec City, Quebec, Canada;
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8
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Kontos AP, Eagle SR, Mucha A, Kochick V, Reichard J, Moldolvan C, Holland CL, Blaney NA, Collins MW. A Randomized Controlled Trial of Precision Vestibular Rehabilitation in Adolescents following Concussion: Preliminary Findings. J Pediatr 2021; 239:193-199. [PMID: 34450120 DOI: 10.1016/j.jpeds.2021.08.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the effectiveness of a 4-week precision vestibular rehabilitation intervention compared with a behavioral management control intervention for adolescents with vestibular symptoms/impairment within 21 days of a concussion. STUDY DESIGN This study used double-blind, randomized controlled trial design involving adolescent (12-18 years) patients with a diagnosed sport/recreation-related concussion with vestibular symptoms/impairment from a concussion-specialty clinic between October 2018 and February 2020. Eligible participants were randomized in a 1:1 to either a 4-week vestibular intervention group (VESTIB) or a behavioral management control group (CONTROL). CONTROLS (n = 25) were prescribed behavioral management strategies (eg, physical activity, sleep, hydration, nutrition, stress management) and instructed to perform stretching/physical activity (eg, walking, stationary cycle) 30 minutes/day. VESTIB (n = 25) were prescribed precision vestibular rehabilitation exercises and instructed to perform at-home exercises for 30 minutes/day. Primary outcomes were improvement in Vestibular/Ocular Motor Screening vestibular items (ie, horizontal/vertical vestibular-ocular reflex, visual motion sensitivity) at 4 weeks postenrollment. RESULTS We screened 310 and enrolled a total of 55 (18%) adolescent patients who were randomized to one of the interventions. Fifty of fifty-five (91%) participants completed all aspects of the study protocol. Participants in VESTIB improved significantly across the intervention period in horizontal (mean difference-1.628; 95% CI [-3.20, -0.06]; P = .04) and vertical (mean difference-2.24; 95% CI [-4.01, -0.48]; P = .01) vestibular-ocular reflex, but not visual motion sensitivity (mean difference-2.03; 95% CI [-4.26, 0.19]) of the Vestibular/Ocular Motor Screening score compared with CONTROLS. CONCLUSIONS Overall, the vestibular intervention group experienced greater clinical improvements in vestibular symptoms/impairment than controls across the 4-week intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT03555370.
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Affiliation(s)
- Anthony P Kontos
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA.
| | - Shawn R Eagle
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
| | - Anne Mucha
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
| | - Victoria Kochick
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
| | - Jessica Reichard
- UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Center for Rehabilitation Services, Pittsburgh, PA
| | - Claire Moldolvan
- UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Center for Rehabilitation Services, Pittsburgh, PA
| | - Cyndi L Holland
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
| | - Nicholas A Blaney
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
| | - Michael W Collins
- Department of Orthopedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA; UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA
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Singman E. From Provider to Advocate: The Complexities of Traumatic Brain Injury Prompt the Evolution of Provider Engagement. J Clin Med 2021; 10:jcm10122598. [PMID: 34204619 PMCID: PMC8231255 DOI: 10.3390/jcm10122598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for a team approach.
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Affiliation(s)
- Eric Singman
- Wilmer Eye Institute, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
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10
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Scheiber B, Schiefermeier-Mach N, Wiederin C. Wirksamkeit manualtherapeutischer Techniken in Kombination mit vestibulärer Rehabilitation nach sportbedingten Gehirnerschütterungen – Eine systematische Übersichtsarbeit randomisiert kontrollierter Studien. PHYSIOSCIENCE 2020. [DOI: 10.1055/a-1098-8140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund Die Rehabilitation nach leichter, sportbedingter Gehirnerschütterung erfordert eine komplexe Behandlung unter Berücksichtigung der muskuloskelettalen, insbesondere zervikogenen, und vestibulären Beteiligung. Das empfohlene Rehabilitationskonzept der vollständigen Ruhe bis zur Beschwerdefreiheit wird inzwischen neu bewertet. Aktuelle Studien deuten auf positive Auswirkungen einer frühen Mobilisierung und multimodaler Physiotherapie hin. Der medizinische Nutzen ausgewählter manualtherapeutischer Techniken wird in mehreren klinischen Studien untersucht. Bisher konnten jedoch keine eindeutigen Empfehlungen für manualtherapeutische Techniken nach einer Gehirnerschütterung ausgesprochen werden.
Ziel Analyse und Zusammenfassung vorhandener randomisiert kontrollierter Studien (RCTs) zur Untersuchung der Wirksamkeit manualtherapeutischer Techniken in Kombination mit vestibulärer Rehabilitation auf Symptomfreiheit und Wiedererlangung der sportlichen Belastbarkeit bei Patienten nach sportbedingten Gehirnerschütterungen.
Methode Systematische Recherche in den Datenbanken ClinicalTrials.gov, WHO-ICTRP, EBSCO, PubMed und PEDro mit den Suchbegriffen concussion, physiotherapy, manual therapy und mild traumatic brain injury. Eingeschlossen wurden RCTs zur Untersuchung manualtherapeutischer Techniken nach sportbedingten Gehirnerschütterungen oder milden Formen eines Schädelhirntraumas. Die Bewertung der methodischen Qualität erfolgte Anhand der PEDro-Skala.
Ergebnisse Publikationen zu 2 RCTs mit guter und moderater methodischer Qualität (PEDro-Skala: 7–8/10 Punkten) sowie eine Folgestudie wurden inkludiert. Als primärer Outcome-Parameter wurde in allen Studien der Zeitraum der ärztlichen Freigabe zur Rückkehr zum Sport angegeben. Sekundäre Outcome-Parameter bezogen sich auf Symptomfreiheit, Postconcussion Scale, Numeric Pain Rating Scale, Balance Confidence Scale, Dizziness-Handicap-Index, Sport Concussion Assessment Tool 2 und Joint-Position-Error-Test. Die Ergebnisse aller inkludierten Studien ergaben signifikante Unterschiede zugunsten der Interventionsgruppen. Die eingeschlossenen klinischen Studien waren jedoch in Bezug auf Design, Methodik und Auswahl der Techniken heterogen, was einen direkten Vergleich erschwerte.
Schlussfolgerung Abgeschlossene klinische Studien deuten darauf hin, dass manualtherapeutische Techniken als Teil eines multimodalen Rehabilitationsprogramms nach Gehirnerschütterungen und leichten Schädelhirntraumata von Nutzen sein können. Aufgrund der geringen Anzahl an RCTs und deren heterogenen Studiendesigns ist eine Bewertung der Wirksamkeit spezifischer manualtherapeutischer Techniken derzeit nicht möglich. Weitere hochwertige Studien sind erforderlich.
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Affiliation(s)
- Barbara Scheiber
- FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Physiotherapie, Innsbruck, Österreich
| | - Natalia Schiefermeier-Mach
- FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Gesundheits- und Krankenpflege, Innsbruck, Österreich
| | - Claudia Wiederin
- FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Physiotherapie, Innsbruck, Österreich
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