4.5 Pediatric concussion assessment of rest and exertion (PedCARE): a multicentre randomized clinical trial

Objective

Investigate whether non-contact physical activity at 72-hours post-acute concussion reduces symptoms at two weeks compared to resting until asymptomatic.

Design

Multicentre blinded randomized clinical trial.

Setting

Three pediatric Emergency Departments (ED).

Participants

Participants aged 10–17 years with acute (< 48 hours) concussion.

Intervention

Participants were randomly assigned to initiate a 4-week stepwise return-to-physical activity at 72-hours post-concussion even if symptomatic [Early Group (EG) protocol] or return-to-physical activity once asymptomatic [Rest Group (RG) protocol].

Outcome Measures

Self-reported post-concussion symptoms at 2-weeks on the Health and Behaviour Inventory (HBI), a validated and reliable 20-item questionnaire. Adverse events were defined as symptoms resulting in an unscheduled ED-visit. Accelerometers were worn 24-hours/day for 14 days post-injury. Group differences and post-concussion symptoms were examined by linear univariable and multivariable analyses adjusting for site and prognostically important covariates. Missing data were imputed.

Results

A total of 456 randomized participants [EG: N=227; median age=13.2(IQR:11.5,14.7); 44.5% female]; [RG: N=229; median age =13.0(IQR:11.6,14.9); 43.7% female] were included in the analyses. No adverse events were reported for either group. EG participants had a median symptom load at 2-weeks of 14.00(IQR: 4.00,22.25) compared to RG participants 16.00(IQR: 7.00,24.00). No strong evidence of an association between early return to physical activity and post-concussion symptoms at 2-weeks was found in univariable [mean difference=-1.2(95%CI:-3.6,1.2] or multivariable analyses [mean difference = -1.0(95%CI:-3.4,1.4].

Conclusion

Among youth with acute concussion, compared to rest until asymptomatic, physical activity initiation at 72-hours post-injury, was safe and did not provoke post-concussion symptoms at 2-weeks. This abstract has been published in full manuscript format and has the following citation: BMJ Citation https://bjsm.bmj.com/content/early/2021/11/25/bjsports-2021-105030