More Physical Activity Reduces Fear Of Movement For Adolescent Athletes With Persistent Post-concussion Symptoms

Abstract

PURPOSE: Physical activity (PA) is recommended to improve concussion recovery time, however, fear of pain with movement (i.e., kinesiophobia) may limit activity. The relationship between PA and kinesiophobia during concussion recovery is unknown. Our purpose was to examine the correlation between PA level and kinesiophobia between initial evaluation and return to play (RTP) clearance among adolescents who did and did not experience persistent post-concussion symptoms (PPCS). METHODS: Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 days post-concussion) and RTP clearance visits. They wore activity monitors that quantified daily step count and exercise frequency and duration between initial and RTP clearance visits. Our primary outcome was TSK score change from initial to RTP visits. We analyzed participants separately based on whether they experienced PPCS (symptoms28 days) or not (symptoms28 days), and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for non-normally distributed variables) between each activity variable and TSK change scores. RESULTS: We enrolled 41 athletes ages 10-18 years diagnosed with concussion who were evaluated within 14 days post-concussion. Among our sample, 44% developed PPCS (n = 18; age = 14.5 ± 2.0 years; 50% female; symptom resolution = 57.3 ± 6.2 days, RTP = 66.8 ± 6.4 days) and 56% did not (n = 23; age = 14.9 ± 1.8 years; 48% female; symptom resolution = 15.2 ± 1.5 days; RTP = 21.7 ± 1.9 days). For the PPCS group, lower TSK change scores were significantly and moderately correlated with higher daily step count (r = -0.60, p = 0.008) and exercise frequency (r = -0.63, p = 0.005), but weakly and non-significantly correlated with exercise duration (rho = -0.12, p = 0.65). Among the no PPCS group, we found weak and non-significant correlations between activity variables and TSK change scores (step count: r = -0.18, p = 0.41; frequency: r = -0.34, p = 0.12; duration: rho = 0.10, p = 0.67). CONCLUSIONS: Higher daily step count and exercise frequency during concussion recovery are moderately correlated with greater reductions in kinesiophobia at RTP among those who experience PPCS. Regular PA during recovery, regardless of duration or intensity, may help reduce kinesiophobia for those with persistent symptoms.