Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery

Abstract

Background:Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes.Purpose:To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes.Study Design:Cohort study; Level of evidence, 3.Methods:Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data.Results:Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) (P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) (P = .002). These variables did not significantly interact.Conclusion:Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.

Concussion Recovery Timeline of High School Athletes Using A Stepwise Return-to-Play Protocol: Age and Sex Effects

“…Increased postconcussion symptoms and longer recovery time in females compared with males have been well documented. 8,[12][13][14] Although direct comparisons with these results are difficult due to differences in recovery criteria, the target age group, and the study design, our results provide additional evidence to support the existence of sex differences in concussion recovery timelines. Zuckerman et al 15 analyzed age groups similar to those in our investigation and reported that females took approximately 2 days longer to return to their baseline total symptom score, which directly agreed with our findings.…”

“…The 12-(n ¼ 2), 13-(n ¼ 18), and 18-(n ¼ 25) year age groups were excluded from the interaction analysis due to inadequate sample sizes. A 2-way ANOVA indicated main effects of sex (P ¼ .048) and age (P ¼ .013), with no interactions (P ¼ .36) between sex and age (14,15,16, and 17 years).…”

Progress and Future Directions of the NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium and Mind Matters Challenge at the US Service Academies

“…Return-to-play timelines in USAFA cadets (mean time of 29.4 days) have also exceeded the commonly cited recovery window of 10 to 14 days (34,35). Similar to the findings of O'Connor et al (33), male (24.7 days) and collegiate athlete-cadets (25.4 days) returned quicker than did female (35.5 days) and non-intercollegiate (34.7 days) cadets (34). In summary, this collection of publications represents the first set of normative values for an underrepresented military population and begins the initial phases of comprehending concussion risk, reporting, and recovery patterns in Service Academy cadets and military service members.…”

“…However, acute symptom burden was the most consistent and robust predictor of recovery time with endorsement of more than 11 symptoms, indicating longer recovery periods (33). Return-to-play timelines in USAFA cadets (mean time of 29.4 days) have also exceeded the commonly cited recovery window of 10 to 14 days (34,35). Similar to the findings of O'Connor et al (33), male (24.7 days) and collegiate athlete-cadets (25.4 days) returned quicker than did female (35.5 days) and non-intercollegiate (34.7 days) cadets (34).…”

“…Additional Service Academy-specific publications have focused on describing the frequency of delayed reporting (31), characterizing factors that may influence concussion risk (32), and describing concussion recovery trajectories (33,34). In a cohort of roughly 300 concussed cadets, 51% failed to immediately report their injury (31).…”