Pediatric Concussion Assessment of Rest and Exertion
Condition: Concussions; Post-Concussive Symptoms
MeSH terms: Post-Concussion Syndrome
Study type: Interventional

Summary: 
      The goal of this study is to investigate when is the best time to resume physical activity
      following a head injury. Two treatment plans will be studied; the first treatment plan
      consists of gradually reintroducing physical activity in the child's routine, starting 72
      hours following the head injury. The second treatment plan involves physical and mental rest
      until the child as no more symptoms. Once symptom free, physical activity is gradually
      reintroduced in the child's routine.
    

Detailed description: 
      Persistent post-concussive symptoms (PPCS) pose long-term challenges and can impact
      negatively patients' health-related quality of life and functional outcomes. Preventing PPCS,
      pediatric concussion guidelines call for cognitive and physical rest. Strict physical
      activity restriction is recommended until symptom-free, followed by a progressive step-wise
      return to activities. Unfortunately, little evidence beyond expert opinion exists to guide
      health care professionals on how and when to best re-introduce physical activity to hasten
      recovery and reduce the burden of PPCS. Recent evidence suggests protracted rest may hinder
      recovery. In fact, early resumption of physical exercise has proven physiological,
      psychological and functional benefits in many other conditions, including stroke (a severe
      traumatic brain injury). Findings from pilot studies in children with PPCS support that
      early, active rehabilitation is associated with improved recovery.

      The goal of this study is to investigate whether early reintroduction of non-contact,
      physical activity at 72-hour post-injury reduces the rate of PPCS in children following an
      acute concussion as compared to usual care stepwise resumption of activity only once fully
      asymptomatic as per the Zurich consensus return-to-play protocol.

      The study is a multicentre, blind, randomized clinical trial. A total of 350 participants
      will be recruited from 3 Pediatric Emergency Research Canada (PERC) Emergency Departments
      (ED). Eligible children are those aged 10-17 years who sustained a concussion in the previous
      48 hours. Participants will be randomized to either the experimental intervention group or
      the the control group. The experimental intervention group consist of resumption of light,
      aerobic exercise (e.g., 15 minute walk) 72 hours post-injury, irrespective of symptoms.
      Patients will be allowed to progress activity daily using one of the following of their
      choice: Frequency, Intensity, Time (duration), or Type, as long as symptoms are
      well-tolerated, with a minimum of 24 hours between each step. Control group: Usual care
      according to Zurich return-to-play guidelines (complete rest until full resolution of
      concussion symptoms [several weeks of rest may be required prior to initiation], followed by
      stepwise activity progression).
    

Intervention name(s): Physical Activity; Rest
Intervention type(s): Behavioral; Behavioral
Intervention description(s): After 72 hours of full physical rest patients will gradually reintroduce physical activity into their daily routine.; Complete physical rest until asymptomatic.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Physical Activity; Rest