Beliefs About the Influence of Rest During Concussion Recovery May Predict Activity and Symptom Progression Within an Active Duty Military Population

Accelerometer-measured habitual physical activity and sedentary time in pediatric concussion: A controlled cohort study

“…A recent study aimed at providing primary care providers with guidelines for de-implementing prolonged rest found that the intervention improved knowledge about avoiding prolonged rest post-concussion, and increased clinician adherence to guideline recommendations from 25% to nearly 90% 43 . Further, per research on military service members with concussion, primary care providers relaying information to patients about the consequences of prolonged rest led to patients more promptly resuming physical activity and self-reporting lower levels of symptoms sooner 44 . Future research should not only continue to build on the evidence, but also ensure that key findings are translated to relevant knowledge users.…”

Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members

“…26 Results also suggested that patients who did not believe in the importance of rest after concussion experienced slower resolution of symptoms. 32 However, providers who over-emphasize rest-and those who fail to track their concussed patients beyond the initial phase of injury-may also overlook critical opportunities to optimize recovery, as excessive rest during post-acute stages of concussion has been shown to prolong symptoms. 29,30,33 Additionally, an emerging literature suggests that guided physical activity can be an effective intervention in the post-acute and chronic phases of recovery.…”

“…This is especially relevant to concussion treatment, as patients' knowledge, beliefs, and expectations about concussion can have a major impact on clinical outcomes after injury. 32,48,49 For example, groups of patients that expect more severe, longer-lasting symptoms after concussion are more likely to actually experience these negative outcomes. 50 Likewise, educational and behavioral interventions aimed at correcting misconceptions and providing realistic expectations for recovery have been found to be effective within both acute and chronic concussion populations.…”

“…[51][52][53][54] Results from the DVBIC PRA study show how these previous findings may apply to implementation of PRA guidelines within a primary care setting: patients who received education from their providers during the acute stage of injury were not only more likely to believe that early rest is important to concussion recovery, but they were also more likely to increase their levels of activity appropriately over time, and they experienced a more rapid reduction in symptoms than patients who did not receive education. 27,32 Training providers on progressive return to activity guidelines As discussed, information about stage of concussion recovery can be used to guide patients through the process of PRA and may hasten their overall recovery toward pre-injury levels of functioning. However, many providers are responsible for providing care for a wide range of different conditions, and so they may lack up-to-date knowledge of best practices for management of concussion.…”

“…In a second phase of the DVBIC PRA study, we sought to evaluate the effects of directly training primary care providers on the DVBIC PRA CR. 11,27,32 Although the DVBIC PRA CR was publicly available online prior to training, providers indicated relatively low rates of exposure to this information before enrollment in the study. Concussion management clinical practices (including the likelihood of providing patient education) varied among primary care managers, both within and between the three military treatment facilities investigated.…”