Randomized Controlled Trial (RCT) Of A Precision Vestibular Treatment In Adolescent Athletes Following Sport-related Concussion

Abstract

Concussion care continues to evolve to incorporate more active treatments such as prescribed exercise (Leddy et al., 2019) and vestibular therapy (Broglio et al., 2015). Consensus statements advocate for randomized controlled trials (RCT) to determine the effectiveness of treatments. To date, there has not been an RCT of precision vestibular treatment in athletes following sport-related concussion (SRC) with vestibular symptoms/impairment. PURPOSE: To determine using an RCT the effectiveness of precision, vestibular treatment compared to standard of care for reducing recovery time, symptoms, and impairment in adolescent athletes with vestibular symptoms/impairment following SRC. METHODS: This study involved an RCT in 50 adolescent athletes with a diagnosed SRC with vestibular symptoms/impairment within 10 days of injury. Participants were randomized to vestibular treatment (i.e., gaze stability, visual motion habituation, dynamic balance, gait) (VEST) or control (i.e., behavioral management) (CTRL), and completed the Dizziness Handicap Inventory (DHI), Modified Balance Error Scoring System (mBESS), Vestibular/Ocular Motor Screening (VOMS), Post-concussion Symptom Scale (PCSS), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) at enrollment and 2- and 4-weeks post-enrollment. Recovery time was recorded using time of medical clearance for full return to activity. Compliance was monitored using daily text messaging. RESULTS: Groups were similar on demographics, initial injury characteristics/severity, and risk factors (all p> .05). mBESS total scores for VESTIB (-1.5) improved more from enrollment to 2-weeks than CONTROLS (-0.3) (p=.04). VESTIB was 8.6x (95% CI= 1.2 - 20.2) more likely to be recovered by 4-weeks than CONTROLS (p=.01). Survival analysis indicated that recovery for VESTIB (45 days) was significantly (p=.04) faster than CONTROLS (57 days). CONCLUSION: The current study provides the first RCT empirical evidence to support the effectiveness of a precision vestibular treatment in adolescent athletes following SRC. Future research should focus on determining the most effective frequency, intensity, and timing for vestibular precision treatments following SRC. Supported by a grant from the Chuck Noll Foundation.