The Wolters Kluwer Health study found that for adolescents with symptoms following a concussion, starting physical therapy (PT) earlier - within less than three weeks after the injury - provides outcomes similar to those of later PT. "Multimodal PT interventions administered by licensed physical therapists may be feasible and safe even within the first few weeks after the injury to help facilitate prompt recovery and mitigate the onset of secondary effects from delayed treatment," wrote Catherine Quatman-Yates.
The researchers looked at how the timing of PT affected the course of concussion-related symptoms in 120 adolescents: 78 females and 42 males, median age 14 years. Physical therapy was classified as early (beginning 0 to 20 days after a concussion) in 27.5 percent of patients, middle (21 to 41 days) in 32.5 percent, and late (42 days or after) in 40 percent.
The PT program consisted of progressive exercise; vestibular/oculomotor training (targeting inner ear/balance and visual symptoms); and cervical spine manual therapy, stretching, and strengthening exercises. Whether started earlier or later, PT led to similar reductions in concussion-related symptoms. The number of sessions and duration of PT care were similar across groups. There was a low rate of adverse events, most of which were unrelated to PT.
Symptoms worsened in a few patients, more commonly in the late PT group. Some of these patients may have had concussion-related impairments not directly addressed by PT, such as anxiety, depression, or sleep problems.
Recent research has led to new insights into medical management of concussion in children and adolescents. Past guidelines recommended complete physical and cognitive (mental) rest after concussion, until symptoms are resolved. But recent studies have suggested that resting for more than a day or two has limited benefits, and may even be linked to increased concussive symptoms.
The new study provides evidence that starting PT earlier is a safe and feasible approach for adolescents after concussion, with improved symptoms regardless of the timing of the intervention. "Introducing PT earlier in the recovery process may be beneficial in minimizing the potential burden of longer recovery trajectories," Dr. Quatman-Yates and coauthors wrote.
The findings appear in The Journal of Neurologic Physical Therapy.
