What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review.

ABSTRACT

OBJECTIVE: To evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents. DESIGN: A systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, ClinicalTrials.gov and Google Advanced. ELIGIBILITY CRITERIA Studies were included if they were original research on RTS following SRC in children aged 5-18 years published in English between 1985 and 2017. RESULTS: A total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%-73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion. CONCLUSIONS: Schools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations. PROSPERO REGISTRATION NUMBER CRD42016039184.