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

Abstract

Objective: To determine the efficacy of early physical activity and behavioral management for acute concussion in pediatric patients.

Study design: A multicenter, prospective, 2 × 2 factorial randomized controlled trial was conducted among patients aged 11-24 years who presented within 72 hours of injury. Participants were randomized into 4 groups based on early physical activity (or usual care [UC]) and behavioral management (or none). The early activity (EA) group was encouraged to meet step targets despite symptoms. The primary outcomes were postconcussion symptom severity and quality of life at 14 days postenrollment.

Results: A total of 239 participants were randomized, and 210 completed all study procedures. The EA group demonstrated higher daily step counts compared with the UC group. However, no significant differences were observed in postconcussion symptom severity or quality of life at 14 days between groups. The EA group experienced higher daily postconcussion symptom severity during the first 7 days and took longer to recover compared with the UC group. Behavioral management showed no effect on outcomes.

Conclusions: Early prescribed physical activity and behavioral management did not improve postconcussion outcomes in the first 2 weeks following injury. Early prescribed activity despite symptoms was associated with delayed symptom resolution.

Trial registration: ClinicalTrials.gov NCT03869970.

Keywords: behavioral intervention; concussion; physical activity; randomized trial.