Related Experiment Video
Updated: Apr 19, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Benefits of strict rest after acute concussion: a randomized controlled trial
Danny George Thomas1, Jennifer N Apps2, Raymond G Hoffmann3
1Departments of Pediatrics, dthomas@mcw.edu.
Insights
Strict rest after pediatric concussion did not improve recovery compared to usual care. In fact, strict rest recommendations led to more reported symptoms and slower symptom resolution in adolescents.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Sports Medicine
Background:
- Concussion management in adolescents often involves rest.
- The optimal duration and type of rest post-concussion remain debated.
- Previous recommendations varied, impacting patient recovery and outcomes.
Purpose of the Study:
- To investigate if strict rest improves concussion recovery and outcomes in adolescents discharged from a pediatric emergency department (ED).
- To compare neurocognitive, balance, and symptom recovery trajectories between strict rest and usual care groups.
Main Methods:
- Adolescents (11-22 years) with concussion were randomized to 5 days of strict rest or usual care (1-2 days rest).
- Assessments included neurocognitive, balance, and daily symptom reporting via diaries.
- Linear mixed modeling analyzed recovery trajectories over 10 days post-injury.
Main Results:
- No significant difference in neurocognitive or balance outcomes between groups.
- The strict rest group reported more daily post-concussive symptoms and slower symptom resolution.
- Strict rest recommendations influenced adolescents' symptom reporting and activity levels.
Conclusions:
- Recommending strict rest for adolescents after concussion provides no additional benefit over usual care.
- Strict rest may negatively impact symptom reporting and prolong perceived recovery.
- Current concussion recovery guidelines for adolescents may need re-evaluation.
Objectives:
To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).
Methods:
Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.
Results:
Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P < .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P < .03) and slower symptom resolution.
Conclusions:
Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest.
