Treatment using the Progressive Return to Activity Clinical Recommendation may return individuals with elevated symptomatology to normal levels at an expedited rate

Abstract

Abstract Objective To determine whether the use of a clinical recommendation (CR) for activity progression to treat concussion will benefit symptom profile months post-injury beyond what is seen with usual care. Methods This study included 58 individuals who participated in the Defense and Veterans Brain Injury Center Progressive Return to Activity (PRA) Study. Eligibility included sustaining a concussion within 72 hours of study enrollment and no previous concussion within 12 months of injury. Poisson regression with robust error variance was used to evaluate the relationship between treatment group assignment (usual care versus PRA-CR) and having normal symptomatology (Neurobehavioral Symptom Inventory score below the upper 10th percentile) at the 1-, 3-, and 6-month follow-up. Participants with normal symptomatology within 72 hours post-injury were excluded from analyses. Results Among participants with abnormal symptoms within 72 hours post-concussion, those receiving the PRA-CR to treat concussion had a 70% (CI = 1.06, 2.72) greater prevalence of normal symptomatology by 1 month post-injury, and a 39% (CI = 1.04, 1.87) greater prevalence of normal symptomatology by 3 months post-injury compared to those receiving usual care. By 6 months post-injury, there was no difference in the prevalence of having normal symptoms between groups. Conclusion The findings of this study show that participants with abnormal symptomatology decreased in symptom level to normal at a faster rate among those receiving the PRA-CR compared to those receiving usual care, providing evidence for the use of the PRA-CR as a means to enhance treatment of patients with concussion.