Effects of Vestibular Rehabilitation in Comparison With Routine Physical Therapy on Stability, Kinesiophobia and Return to Sports in Athletes With Post Concussion Syndrome
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Enrollment
- 34
- Primary Endpoint
- Kinesiophobia
Study Overview
Brief Summary
This randomized controlled trial with a parallel design was conducted over six months at Ghurki Trust Teaching Hospital to compare the effects of Vestibular Rehabilitation and Routine Physical Therapy on stability, kinesiophobia, and return to sports in athletes with post-concussion syndrome. A total of 34 participants aged 12 to 30 years were enrolled based on specific diagnostic criteria. Non probability convenient sampling was used, followed by random allocation into experimental and control groups through computer generated sequencing and sealed envelope concealment. Single blinding was done, with participants unaware of their assigned intervention.
The experimental group received a Vestibular Rehabilitation program consisting of balance training, habituation exercises, and gaze stabilization, while the control group underwent Routine Physical Therapy involving ankle strategies and elliptical training. Both interventions were administered for 30 minutes, three times per week, over four weeks. Outcomes were measured pre- and post-intervention using validated tools: the Balance Error Scoring System (BESS) for postural stability, the Urdu version of the Tampa Scale of Kinesiophobia (TSK), and the Injury Psychological Readiness to Return to Sport Scale (I-PRRS). Data analysis was performed using SPSS version 26, employing appropriate parametric or non-parametric tests based on normality, with significance set at p < 0.05. Ethical approval was obtained, informed consent was secured, and all procedures adhered to established ethical standards.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 12 Years to 30 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age 12 to 30 years
- •Fulfil the criteria of post concussion syndrome as highlighted by Tator et al.(2016)which requires presence of at least 3 or more persistent symptoms from standardized list
- •Sustained a mTBI in past 3 to 12 weeks
- •Having ongoing symptoms from list in PCSS that started 72 hrs or less after an impact
- •Exhibit objective deficits on standardized baseline examination enabling vestibular and ocular dysfunction
Exclusion Criteria
- •Have a chronic infectious disease.
- •Uncontrolled hypertension.
- •Other neurological disorders (not attributed to their primary diagnosis).
- •Cancer treatment (other than basal cell carcinoma), craniotomy, or refractory subdural hematoma.
- •Those on long term use of psychoactive drugs that compromise their ability to perform study activities
- •Those with pacemakers or elevated cardiovascular risk.
- •Ongoing litigation surrounding their injury.
- •Have been diagnosed with a severe brain injury prior to enrollment, or their post concussive symptoms have persisted beyond 12
Arms & Interventions
Vestibular Rehabilitation
The experimental group received a structured Vestibular Rehabilitation Program that included balance training, habituation exercises, and gaze stabilization exercises. These interventions were designed to improve postural stability, reduce dizziness and motion sensitivity, and enhance visual vestibular interaction. Each session lasted 30 minutes, was conducted three times per week, and continued for a total of four weeks under the supervision of a licensed physical therapist.
Intervention: Intervention 1 (Other)
Routine Physical Therapy
The control group received Routine Physical Therapy, consisting of ankle strategy exercises to improve postural control through ankle musculature and coordination, along with elliptical training at sub-symptom threshold levels to promote aerobic conditioning. Similar to the experimental group, these sessions were performed for 30 minutes, three times per week, for four weeks, and were supervised by a licensed physical therapist.
Intervention: Control Arm (Conventional Therapy) (Other)
Outcomes
Primary Outcomes
Kinesiophobia
Time Frame: 4 weeks
For kinesiophobia the Urdu version of Tampa scale was used to asses athletes. The Urdu version of the TSK is considered to be a valid and reliable tool for assessing kinesiophobia. 1. = strongly disagree 2. = disagree 3. = agree 4. = strongly agree Tampa Scale for Kinesiophobia (TSK) The TSK is a self report questionnaire used to measure fear of movement. It contains 17 items, each scored on a 4-point Likert scale: Total score range: 17 to 68 Reverse scored items: 4, 8, 12, 16 (For these items: 1↔4, 2↔3)
Stability
Time Frame: 4 weeks
The Balance Error Scoring System (BESS) has demonstrated excellent validity and reliability in patients. Test-retest reliability was strong, with ICC values ranging from 0.88 to 0.99 (average 0.90) and Cronbach's alpha between 0.90 and 0.99, indicating high internal consistency.Types of Errors Hands lifted off the iliac crest Opening eyes Step, stumble, or fall Moving hip into \>30° abduction Lifting forefoot or heel Remaining out of the test position for more than 5 seconds The BESS is calculated by adding one error point for each error during the six 20-second tests. Which Foot Was Tested * Left * Right (i.e., the non-dominant foot) Score Card (Number of Errors) Test Condition Firm Surface Foam Surface Double-Leg Stance (feet together) Single-Leg Stance (non-dominant foot) Tandem Stance (non-dominant foot in back) Total Scores: BESS Total:60
Return to sports
Time Frame: 4 weeks
The Injury Psychological Readiness to Return to Sport (I-PRRS) scale was selected as it has undergone translation and validation in Dutch athletes. The instrument demonstrated strong internal consistency (Cronbach's α = 0.94) and excellent test-retest reliability (ICC = 0.89). 0 = no confidence at all, 50 = moderate confidence, 100 = complete confidence. Rate Value My overall confidence to play is \_\_\_\_\_\_\_\_ My confidence to play without pain is \_\_\_\_\_\_\_\_ My confidence to give 100 percent effort is \_\_\_\_\_\_\_\_ My confidence to not concentrate on the injury is \_\_\_\_\_\_\_\_ My confidence in the injured body part to handle the demands of the situation is \_\_\_\_\_\_\_\_ My confidence in my skill level/ability is \_\_\_\_\_\_\_\_ Total: \_\_\_\_\_\_\_\_
Secondary Outcomes
No secondary outcomes reported