期刊
CLINICAL JOURNAL OF SPORT MEDICINE
卷 31, 期 1, 页码 23-30出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JSM.0000000000000683
关键词
head injury; mild traumatic brain injury; return to activity; youth; risk stratification
This study indicates that graded exercise testing post-concussion can predict recovery trajectory. Patients were divided into exercise-tolerant and exercise-intolerant groups, with the former showing faster recovery. The combined use of exercise testing and clinical testing was highly predictive of outcomes.
Objective: To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents. Design: Prospective study. Setting:Children's Hospital, Westmead, Australia. Participants:One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury. Intervention:Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured. Main Outcome Measures: Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators. Results: Participants (mean age 12.4 +/- 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 +/- 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 +/- 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome. Conclusions: Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.
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