Defining return-to-learn through an evidence-based systematic review

Academic recovery following concussion has been defined in various contexts, however, these definitions vary considerably leading to heterogenous data and limited application. Standardized definitions have also been published, though their formation are not transparently described. Therefore, this research aimed to report the various operational definitions of return-to-learn, return-to-school, return-to-class, and return-to-academics found within the literature and propose evidence-based definitions for return-to-learn (RTL).

We searched PubMed and ScienceDirect for eligible studies that were (i) published in a peer-reviewed journal between January 2010, to January 2023, (ii) originally published in English, and (iii) had a full text available, (iv) measured RTL, return-to-school, return-to-the-classroom, or return-to-academics within a student sample, and (v) provided a clear definition or description of RTL completion criteria. Definitions of RTL, return-to-school, return-to-the-classroom, or return-to-academics along with outcome measure data (recovery times, group data, etc.) were extracted independently by three researchers and reached unanimous agreement.

The review yielded 456 articles, with 24 meeting inclusion criteria. Five recovery criteria were used across the studies: (i) guided protocols, (ii) clinician determinations/clearance, (iii) school attendance and days missed, (iv) resumption of full academic workload, and (v) full-time without accommodations. The proposed definition of RTL for college/universities is when the following criteria are met, (i) resolution of injury-associated symptoms, with and without academic engagement, (ii) resume pre-injury usage of accommodations, (iii) full academic participation-attend all registered courses, once minimum, attendance for the full time, (iv) cognitive functioning is stable and consistent with pre-injury baseline. The proposed definition of RTL for middle and high schools when the following criteria are met, (i) tolerates full academic demands without recurrence or worsening of injury-associated symptoms, (ii) has returned to their typical school schedule and workload, including extracurricular academic activities if applicable, (iii) no longer requires modified cognitive activity levels or informal classroom supports, (iv) demonstrates stable cognitive functioning consistent with their pre-injury baseline.

Academic recovery is defined by the literature in various ways, creating limited reproducibility of data. RTL definitions also display several gaps that do not account for logistical factors influencing return-to-learn across university and K-12 settings. Definitions lack a holistic approach, indicating that students may be prematurely satisfying recovery criteria. Novel definitions of recovery that are specific to the students individualized academic path, yet representative of the academic setting, are needed. The proposed definitions account for these variables, while remaining evidence-based.