P. Langevin1,2, P. Frémont1, P. Fait3, M.-O. Dubé1,2, M. Bertrand-Charette1,2, J.-S. Roy1,2
1Université Laval, Rehabilitation, Quebec, Canada, 2Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada, 3Université du Quebec à Trois-Rivières, Kinesiology, Trois-Rivières, Canada
Background: Concussion or mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 30% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headaches and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated.
Purpose: The objective of this study wasto compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms following mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery.
Methods: In this single-blind, parallel-group randomized controlled trial, 60 adults with persistent symptoms following mTBI were randomly assigned to: 1) a 6-week SLAE program or 2) a 6-week cervicovestibular rehabilitation program combined with SLAE program. All participants took part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Nonparametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes.
Results: For PCSS, NPRS, NDI, HDI, DHI and return to function, there were no group-by-time interactions at any time-point follow-up (p>0.05); clinically significant time effects were, however, observed (p < 0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p < 0.003) and the cranio-vertebral mobility (p < 0.001) measures in favour of the cervicovestibular rehabilitation group.
Conclusions: The study indicates that acervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in terms of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function.
Implications: Clinicians should prescribe symptom-limited aerobic exercise programs and provide education to improve symptoms and function when symptoms persist following a concussion / mTBI. Cervical and vestibular physiotherapy should be performed when cervical or vestibular impairments are found because these impairments persist over time if they are not treated. Future studies on adults with mTBI should explore
1) the effect of cervical and vestibular impairments on other patient-centred outcomes (i.e., quality of life, satisfaction) and
2) which subgroup of patients (i.e., mTBI with confirmed whiplash-associated disorder) would benefit from a cervicovestibular rehabilitation program to improve symptoms and function.
1) the effect of cervical and vestibular impairments on other patient-centred outcomes (i.e., quality of life, satisfaction) and
2) which subgroup of patients (i.e., mTBI with confirmed whiplash-associated disorder) would benefit from a cervicovestibular rehabilitation program to improve symptoms and function.
Funding acknowledgements: Funding was provided by REPAR ([email protected]) and OPPQ ([email protected]).
Keywords:
Concussion
Mild traumatic brain injury
Cervicovestibular physiotherapy
Concussion
Mild traumatic brain injury
Cervicovestibular physiotherapy
Topics:
Sport & sports injuries
Disability & rehabilitation
Musculoskeletal: spine
Sport & sports injuries
Disability & rehabilitation
Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: Centre Integré Universitaire Santé Services Sociaux - Capitale Nationale
Committee: Sectorial Rehabilitation and Social Integration Research Ethics Committee
Ethics number: 2018-619
All authors, affiliations and abstracts have been published as submitted.
