A new study indicates that early initiation of physical therapy (PT) for youth diagnosed with concussions is safe and tolerable. The retrospective analysis, published in PMC, examined the outcomes of multimodal, impairment-based PT interventions initiated at varying time points after injury. The findings suggest that PT can be safely implemented within the first three weeks post-injury, potentially mitigating the negative effects of prolonged rest.
The study, conducted at a large metropolitan children’s hospital, analyzed data from 120 patients aged 12-21 who received outpatient PT services for concussion-related complaints. Patients were categorized into three cohorts based on the timing of PT implementation: early intervention (0-20 days post-injury), middle intervention (21-41 days post-injury), and late intervention (42 or more days post-injury).
The primary outcome measure was the Post-Concussion Symptom Inventory (PCSI) score, a self-reported measure of 21 post-concussion symptoms. Secondary outcome measures included the number of PT sessions, duration of the PT episode of care, and the occurrence of unplanned visits to a healthcare provider.
Key Findings
The study revealed no significant differences between the intervention cohorts regarding symptom change on the PCSI from the beginning to the end of the PT episode of care (p = 0.38). Additionally, there were no significant differences in the number of PT sessions (p = 0.21) or the duration of the PT episode of care (p = 0.19) across the groups. The rate of unplanned healthcare visits due to symptom exacerbation was low (5.8% overall), with no statistical difference between cohorts.
Clinical Implications
These results suggest that multimodal, impairment-based PT is likely safe for youth with concussions, regardless of the timing of initiation. The study supports the feasibility of incorporating PT earlier into the concussion plan of care, potentially minimizing the burden of longer recovery trajectories.
Expert Commentary
"The timing of PT services is an important component to consider when determining the most appropriate care for this patient population as there is growing concern regarding the negative effects of prolonged physical and cognitive rest," the researchers noted. They emphasized that emerging evidence suggests strict, prolonged rest following concussion may actually lengthen the recovery process.
Study Limitations
The authors acknowledged several limitations, including the retrospective design, which prevents definitive conclusions regarding safety and tolerability. They also noted the potential for selection bias in physician referral patterns and the lack of a control group. The sample size, while larger than previous studies, may have limited the statistical power to capture differences between the cohorts.
Future Directions
Future prospective studies are needed to validate these findings and identify the most optimal and appropriate plan of care for youth with concussions. These studies should aim to provide confirmatory and explanatory evidence regarding the optimal timing for the initiation of PT services.
