What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review

Purcell, Laura; Davis, Gavin A; Gioia, Gérard A.

doi:10.1136/bjsports-2017-097853

Cited by 60 publications

(54 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though no retrieved articles evaluated the effectiveness of school accommodations, four consensus documents provided recommendations for school accommodations 1 9 29 37. Their common goal was to increase student participation without exacerbating symptoms.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

DeMatteo

Bednar

Randall

et al. 2020

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

Objective To determine the effects of following return to activity (RTA) and return to school (RTS) protocols on clinical outcomes for children with concussion. The 12 subquestions of this review focus on the effectiveness of protocols, guidelines and recommendations, and the evidence supporting content of the protocols including rest, exercise and school accommodations.Design Systematic review. Data sources PubMed, MEDLINE, EMBASE, CINAHL, ERIC and manual reference list check.Eligibility criteria for selecting studies Studies were included if they evaluated RTA or RTS protocols in children aged 5-18 years with a concussion or if they reported a rigorous study design that provided evidence for the recommendations. Included studies were original research or systematic reviews. Articles were excluded if they did not report on their methodology or included participants with significant neurological comorbidities. ResultsThe literature search retrieved 198 nonduplicate articles and a total of 13 articles were included in this review. Despite the adoption of several RTS and RTA protocols in clinical practice there is little evidence to determine their efficacy in the paediatric population.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Their common goal was to increase student participation without exacerbating symptoms. Medical and school-based teams should collaborate to counsel the student regarding gradually increasing the duration and intensity of academic activities 29 37. Protocols to RTS need to be personalised based on the severity of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

DeMatteo

Bednar

Randall

et al. 2020

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

show abstract

“…9,11,18 Our finding that adequate school accommodations were associated with improved school HRQOL in SRC patients provides support for providing SRC patients with return-to-learn programs that allow students to make a gradual return to school and help minimize cognitive-related symptoms. 20,32,33 Future studies are needed to address the added clinical value of incorporating patient-reported HRQOL outcome measures into the standardized management of patients with acute concussion and PCSS.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study

Russell

Selci

Black³

et al. 2019

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEThe longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients.METHODSThe authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13–18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale.RESULTSA total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients’ initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery.CONCLUSIONSAdolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.

show abstract

“…Given that being a student is the primary occupation of childhood through to young adulthood, an emphasis on returning to school should be a top priority for children and families, more so than return to sport (22, 23). However, to date the emphasis in post-concussion management has been on return to play and sports (20, 21).…”

Section: Introductionmentioning

confidence: 99%

What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose

et al. 2019

View full text Add to dashboard Cite

Objectives: Return to School (RTS) and Return to Activity/Play (RTA) protocols are important in concussion management. Minimal evidence exists as to sequence and whether progression can occur simultaneously. Experts recommend that children/youth fully return to school before beginning RTA protocols. This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols. Methods: In a 3-year prospective-cohort study of 139 children/youth aged 5–18 years with concussive injury, self-reported symptoms using PCSS and stage of protocols were evaluated every 48 h using electronic surveys until full return to school and activity/sport were attained. Information regarding school accommodation and achievement was collected. Results: Sample mean age is 13 years, 46% male. Youth are returning to school with accommodations significantly quicker than RTA ( p = 0.001). Significant negative correlations between total PCSS score and stage of RTS protocol were found at: 1-week ( r = −0.376, p < 0.0001; r = −0.317, p = 0.0003), 1-month ( r = −0.483, p < 0.0001; r = −0.555, p < 0.0001), and 3-months ( r = −0.598, p < 0.0001; r = −0.617, p < 0.0001); indicating lower symptom scores correlated with higher guideline stages. Median full return to school time is 35 days with 21% of youth symptomatic at full return. Median return time to full sport competition is 38 days with 15% still symptomatic. Sixty-four percent of youth reported experiencing school problems during recovery and 30% at symptom resolution, with 31% reporting a drop in their grades during recovery and 18% at study completion. Conclusions: Children/youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during stages 1–3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. Ther...

show abstract

What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review

Cited by 60 publications

References 61 publications

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study

What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose

Contact Info

Product

Resources

About