Guided Physical Exertion in Sports-Related Concussion Patients (P6.309)

Objective: To determine if guided sub-symptomatic threshold physical exertion hastens recovery from sports-related concussion. Background: The management of sports-related concussion (SRC) has evolved over time. The most recent consensus statement suggests return of light activity after a period of 24–48 hours of relative physical and cognitive rest. The amount and timing of activites, and effects of cognitive and physical activity on recovery after SRC are not determined. In this study, we reviewed the use of guided sub-symptomatic threshold physical exertion after SRC in the University of Michigan NeuroSport Clinic to determine if it affects symptom improvement and return to sport outcomes. Design/Methods: This is a retrospective chart review of SRC patients from September 2016 through January 2017. Patients who underwent controlled physical exertion while symptomatic within 15 days of their concussion were included in the intervention group. Those who did not undergo this testing, were asymptomatic at time of testing, or who underwent testing after 15 days from their concussion were included in the non-intervention group. Statistical analysis was performed using a Cox regression model and controlled for multiple co-variates: age, provider, previous concussions, neck pain, neurologic exam abnormalities (vestibular and oculomotor), co-morbidities (migraines, depression/anxiety, ADHD/learning disability), treatments (physical and vestibular therapy), and the relationship between time to clinic presentation and exertional testing. Results: 121 patients were included in the analysis. Population characteristics were similar between intervention and non-intervention groups. There was a statistically significant association between the intervention and time to return to sport (p=0.031, HR=2.07). Conclusions: Guided sub-symptomatic exercise testing performed in the early stages of a sports-related concussion was associated with more rapid symptom resolution, and return to sport. Early physical activity was not associated with prolong recovery or worsened symptoms. Disclosure: Dr. Popovich has nothing to disclose. Dr. Almeida has nothing to disclose. Dr. Lorincz has nothing to disclose. Dr. Sas has nothing to disclose.