Effects of Physiotherapy in Individuals With Persistent Symptoms Following Concussion

Study Overview
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Brief Summary
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The purpose of this study is to determine the effects of a combined physiotherapy treatment (including vestibular rehabilitation and treatment for the cervical spine) in youth and young adults with ongoing symptoms of dizziness, neck pain and headaches following a sport-related concussion.

Official Title
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Physiotherapy Treatment (Including Vestibular Rehabilitation) Compared to Rest in Individuals With Persistent Symptoms of Dizziness, Neck Pain and/or Headache Following Sport-related Concussion.

Conditions
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Sport-related Concussion

Intervention / Treatment
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* Other: Control postural education, general range of motion and strengthening in addition to the standard of care
* Other: Physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of Sport-related concussion as per the Third International Consensus Guidelines Persistent symptoms (greater than 10 days) of dizziness, unsteadiness, neck pain and/or headaches reported on the Sport Concussion Assessment Tool 2 (SCAT2) Clinical examination findings suggesting vestibular and/or cervical spine involvement Exclusion Criteria: Fracture, other neurological conditions, musculoskeletal injuries (other than the cervical spine) that restrict activity and medications that affect neural adaptation

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physiotherapy<br>Physiotherapy: including vestibular rehabilitation and multimodal treatment for the cervical spine, once weekly with the study physiotherapist for 8 weeks or until time of medical clearance to return to sport. This group also received the control intervention. | Other: Control postural education, general range of motion and strengthening in addition to the standard of care<br>* Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport.<br>Other: Physiotherapy<br>* Physiotherapy: including vestibular rehabilitation and multimodal treatment for the cervical spine, once weekly with the study physiotherapist for 8 weeks or until time of medical clearance to return to sport.<br>|
| Active Comparator: Control<br>Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport. | Other: Control postural education, general range of motion and strengthening in addition to the standard of care<br>* Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days to medical clearance to return to sport | Number of days to medical clearance by study physician | up to 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Numeric Pain Rating Scale Score-Neck Pain | Self-reported cervical spine pain rated on a scale of 0-10 | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Numeric Dizziness rating Score | Self reported dizziness on a scale of 0-10 | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Numeric Pain Rating Scale Score-Headache | Self-report score for headache on a scale of 0-10 | Change between Baseline and 8 weeks or at time of medical clearance | 
| Change in Activities Specific Balance Confidence Scale Score | Self report measure of confidence during 16 balance activities | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Dizziness Handicap Index Score | Self report measure evaluating perceived handicap secondary to dizziness | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Sport Concussion Assessment Tool 2 (SCAT2) | Multifaceted tool used in the assessment of concussion and includes domains of symptom report, cognitive function, balance and coordination | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Dynamic Visual Acuity | Assessed clinically using an eye chart and a metronome set at 2 Hz. Static visual acuity is measured 13 feet from the target. The subjects head is rotated at 2 Hz and visual acuity is measured dynamically. The difference between static and dynamic visual acuity is calculated. | Change between Baseline and 8 weeks or time of medical clearance | 
| Head Thrust Test | Clinical test performed in sitting with head flexed and high velocity low amplitude motion into 5-15 degrees rotation is performed while the subject is asked to maintain focus with the examiner's nose. | Baseline and at 8 weeks or time of medical clearance | 
| Change in modified Motion Sensitivity Test Score | Patient report of intensity and duration of dizziness with eight head or body motions | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Functional Gait Assessment Score | Dynamic Balance Measure that includes 10 different movements and the ability to complete each activity is rated by the examiner. | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Cervical Flexor Endurance | Test to evaluate the time (seconds) that an individual can maintain the head in a position of craniovertebral flexion and two finger widths above a pillow in crook lying. | Change between Baseline and 8 weeks or time of medical clearance | 
| Change in Joint Position Error | Clinical test using a laser pointer affixed to a head piece on top of the head that is projected onto a bull's eye target. Subject rotates head to left, right (rotation) or up (extension) to the maximum comfortable range and relocates to the perceived point of neutral head position with eyes closed. A measures from the centre of the bull's eye is recorded. A mean of three trials is recorded for each direction. | Change between Baseline and 8 weeks or time of medical clearance | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sport-related concussion, Dizziness, Neck pain, Headaches, Physiotherapy, Treatment