Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario.

Identifying vulnerability factors for developing persisting concussion symptoms is imperative for determining which patients may require specialized treatment. Using cross-sectional questionnaire data from an Ontario-wide observational concussion study, we compared patients with acute concussion (≤ 14 days) and prolonged post-concussion symptoms (PPCS) (≥ 90 days) on four factors of interest: sex, history of mental health disorders, history of headaches/migraines, and past concussions. Differences in profile between the two groups were also explored. 110 patients with acute concussion and 96 patients with PPCS were included in our study. The groups did not differ on the four factors of interest. Interestingly, both groups had greater proportions of females (acute concussion: 61.1% F; PPCS: 66.3% F). Patient profiles, however, differed wherein patients with PPCS were significantly older, more symptomatic, more likely to have been injured in a transportation-related incident, and more likely to live outside a Metropolitan city. These novel risk factors for persisting concussion symptoms require replication and highlight the need to re-evaluate previously identified risk factors as more and more concussions occur in non-athletes and different risk factors may be at play.

Does interprofessional concussion management improve recovery in varsity athletes? A year to year effectiveness-implementation hybrid study.

OBJECTIVES: The main purpose of this study was to explore the effectiveness of an integrated interprofessional management (IPM) concussion care approach in varsity athletes. SETTING: The study was completed in a university environment with varsity athletes. DESIGN: Data analysis was quantitative, as compared between seasons, in this observational cohort study. MAIN OUTCOME MEASURES: The metrics for the effectiveness of the IPM team were: time spent in treatment and post-concussion symptom severity scores. These measures were compared for each season year and both sexes for the primary concussive domain they were initially diagnosed with. PARTICIPANTS: University varsity athletes from various in-season teams. RESULTS: A Kruskal-Wallis revealed that 2017/18 athletes spent a significantly shorter amount of time in treatment between the two seasons, median 29 days in the 2016/17 season year (IQR = 29) versus 13 days in the 2017/18 season year (IQR = 11), for both sexes (p = 0.009). It appears women tended to recover more quickly than men, particularly in the 2016/2017 season first year. CONCLUSIONS: A highly communicative interprofessional management (IPM) strategy was shown to lead to reduced return to play (RTP) and return to learn (RTL) times. Increased experience as an IPM team may be a factor contributing to the effectiveness in IPM strategies as well as overall concussion treatment.

Exploring the role of cervical spine endurance as a predictor of concussion risk and recovery following sports related concussion.

BACKGROUND: Concussions have become a significant public health concern with rising incidence rates. Concussions have been shown to occur concurrently with neck injuries, such as whiplash-associated-disorder, therefore, understanding the role of the neck in concussions is important. OBJECTIVES: To determine if there is a relationship between cervical muscle endurance and either concussion incidence, or concussion recovery in university athletes. Specifically, the primary aim was to investigate a relationship between pre-season deep neck flexor endurance test (DNFET) time in those who sustained an in-season injury versus those who did not. The secondary aim is to determine correlation in DNFET times and concussion recovery. DESIGN: Longitudinal observational study. METHODS: Pre-season DNFET was performed on university athletes. In the event of a concussion, cervical endurance and neuromuscular adaptation was re-assessed with the DNFET. Rehabilitative exercises were prescribed, as required, and DNFET was measured at subsequent treatments. RESULTS: There was no significant difference between pre-season DNFET times and concussion incidence (p = 0.55). However, there was a moderate correlation between DNFET times and concussion recovery (R = 0.47, p = 0.001) whereby DNFET times improved predictively throughout rehabilitation. CONCLUSIONS: While no statistically significant relationship was found between DNFET and concussion incidence, a significant clinical relationship was present with recovery. The validity of the DNFET test as a means for assessing risk or measuring recovery requires additional research.