A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury.

Abstract

There is a paucity of effective management strategies to prevent prolonged symptoms following mild traumatic brain injury (mTBI), and emerging evidence suggesting possible benefits of exercise. The objective of this trial was to determine whether adult patients presenting to the emergency department (ED) with a diagnosis of acute mTBI prescribed light exercise were less likely to develop persistent postconcussion symptoms (PCS). This was a randomized controlled trial conducted in three Canadian EDs. Consecutive, adult (18-64years) ED patients with an mTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise, and the control group was given standard mTBI instructions advising gradual return to exercise following symptom resolution. The primary outcome was the proportion of patients with PCS at 30days, defined as the presence of three or more symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ). A total of 367 patients were enrolled (control group, n=184; intervention, n=183). Median age was 32years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30days (control, 13.4% vs intervention, 14.6%; ∆1.2%, 95% confidence interval [CI]= -6.2 to 8.5). There were no differences in median change of RPQ scores, median number of return health care provider visits, median number of missed school or work days, or unplanned return ED visits within 30days. Participants in the control group reported fewer minutes of light exercise at 7days (30 vs 35; ∆5, 95% CI= 2 to 15). In this trial of prescribed early light exercise for acute mTBI, there were no differences in recovery or health care utilization outcomes. Results suggest that early light exercise may be encouraged as tolerated at ED discharge following mTBI, but this guidance is not sufficient to prevent PCS.