Impact of Early Activity and Behavioral Management on Acute Concussion Recovery: A Randomized Controlled Trial

Area of Science:

• Pediatric neurology
• Sports medicine
• Rehabilitation science

Background:

• Acute concussion management in pediatric patients is evolving.
• The role of early intervention, including physical activity and behavioral strategies, requires further investigation.
• ClinicalTrials.gov identifier: NCT03869970.

Purpose of the Study:

• To evaluate the efficacy of early physical activity and behavioral management for acute concussion in pediatric patients.
• To assess the impact of these interventions on postconcussion symptom severity and quality of life.
• To determine if early activity despite symptoms influences recovery time.

Main Methods:

• A multicenter, prospective, 2 × 2 factorial randomized controlled trial.
• Involved 239 pediatric patients (aged 11-24 years) presenting within 72 hours of concussion.
• Compared four groups: early activity (EA) vs. usual care (UC), and behavioral management vs. none.

Main Results:

• The early activity group showed higher daily step counts but no improvement in symptom severity or quality of life at 14 days.
• The EA group experienced increased symptom severity in the first week and a longer recovery period.
• Behavioral management interventions did not demonstrate a significant effect on concussion outcomes.

Conclusions:

• Early prescribed physical activity and behavioral management did not enhance postconcussion outcomes within the initial two weeks.
• Engaging in early physical activity despite concussion symptoms was associated with delayed symptom resolution.
• Current findings suggest a need to reconsider early, symptom-permissive physical activity protocols for pediatric concussion.