Written by Hannah Harp
Spoon Feed
This 2×2 RCT found early activity and behavioral management did not benefit children with concussion beyond usual care, though adherence was poor.
Back to play, the smart way
It’s back to concussions this week! We’ve recently covered concussion, looking at return-to-play guidelines and more. Current guidelines are to start light aerobic activity within 72 hours of injury and for patients to self-limit this activity by the appearance or worsening of symptoms. Activity is gradually advanced until the patient can tolerate vigorous exercise. This study adds some information about the importance of the “self-limiting” part and also addresses behavioral health concerns during concussion recovery.
Among 239 participants aged 11–24, no significant differences were found in symptom burden (post-concussion symptom scale, PCSS day 14: early activity = 20.1 vs usual = 17.1; p=NS) or quality of life. Early activity delayed symptom resolution (median 10 vs 5 days; p=0.03), and patients in the early activity group also reported more severe symptoms during the first week of the study. Behavioral management via app use showed no clinical benefit.
The major limitation for this study was adherence – only about 38% of the patients assigned to the early activity arm completed the prescribed activity. About half of the patients in the mHealth arm were able to complete a significant portion of the curriculum. Either way, this really detracts from the power of the study. As the authors describe, this may have been improved by supervision of activity, but I think this gives us a realistic look at how families are managing concussion at home.
How will this change my practice?
It’s good to have more evidence backing up the recent changes to concussion management. Just like strict rest leads to prolonged symptoms, it seems that pushing too hard does the same.
Source
Impact of Early Activity and Behavioral Management on Acute Concussion Recovery: A Randomized Controlled Trial. J Pediatr. 2025 Apr 18:114596. doi: 10.1016/j.jpeds.2025.114596. Epub ahead of print. PMID: 40254050
