Symptom Recovery and Return to Participation Timelines of Patients With Concussion at a Community Physiotherapy Clinic Based on Injury Mechanism

Objective To compare patient demographics, injury phase (IP; time-to-assessment), total symptom severity score (TSS) changes and return to participation (RTP; cognitive/physical) to mechanism of injury (MOI).

Background Secondary concussion prevention includes timely assessment and treatment to decrease TSS and maximize RTP.

Design/Methods One community physiotherapy clinic. Retrospective chart review (September 1, 2016–August 8, 2018). Two hundred thirty-four patients with concussion (male: n = 85; female: n = 149) from various MOIs. Age groups (years): children 8–12, youth 13–17, young adult 18–29, adult 30–64, senior 65+. IP: acute (<72 hours), subacute (72 hours-2 weeks adults, 72 hours-4 weeks children/youth), persistent (2 weeks-3 months adults, 4 weeks-3 months children/youth), chronic (>3 months). Intervention: multimodal physiotherapy (cervico-vestibular, exertion, education), referral to specialist, psychology and/or neuropsychology. Outcome measures: treatment (number, timeframe) and weeks to recovery (WTR) vs MOI; TSS changes and RTP rates.

Results All acute IP had sport MOI, with WTR consistent with current literature. For all others, WTR was longer regardless of age or MOI. MVC and other MOIs were primarily patients in persistent or chronic IP (80% and 71%, respectively). MVC had the longest recovery (12.28 ± 8.21 treatments over 21.03 weeks 95% CI [17.05, 25.01], 44.94 WTR 95% CI [36.38, 53.51]); p < 0.05). Sport MOI received 5.50 ± 3.62 treatments over 7.49 (95% CI [5.59, 9.40]) weeks and 19.07 (95% CI [13.72, 24.42]) WTR. No significant statistical difference was observed between sport and other MOI recovery. TSS decreased in 85% of all patients. Full cognitive RTP was achieved by 75% of patients, and full physical RTP by 68%.

Conclusions Concussion patients experienced symptom and participation recovery, with IP and MOI related to WTR. Treatment/recovery timeframes were longer than previously reported for subacute, persistent, and chronic IPs. These results will inform secondary prevention strategies and knowledge translation underscoring the need for timely assessment and treatment. It also draws attention to RTP in MOIs other than sport.