Concussion, Mild, Mild Traumatic Brain Injury
Conditions
Keywords
Concussion, Mild traumatic brain injury, Aerobic exercise
Brief summary
This study is looking at the specific role of an exercise prescription on recovery from concussion symptoms in the general population.
Detailed description
435 people will participate in this study. A physician will review a participant's medical history to determine if physical activity is appropriate for them. They will then be randomly assigned to 1 of 3 study groups: 1. Monitoring- participants will be given a heart rate monitor to wear on their wrist for the duration of the study (until recovered, or until 8 weeks post-concussion, whatever comes first). 2. Monitoring + Treadmill Testing- in addition to wearing the heart rate monitor, they will undergo a treadmill test at each appointment. 3. Monitoring + Treadmill Testing + Specific Exercise Prescription- in addition to wearing the heart rate monitor, and treadmill test, they will receive an exercise prescription based on the results of the treadmill test. The randomization is by chance. Participants have a 40/20/40% respective chance of being assigned to the study groups above. This means that out of every 5 people: 2 people will be assigned to the group 1, 1 will be assigned to the group 2, and 2 will be assigned to the group 3. Both participants and the study doctor will be aware which group participants are in. Regardless of the group assigned, participants will receive an exercise prescription form at each appointment, as per usual care. The prescription will be based on the physician's judgement. If a participant is in group 3, their prescription will also take into account the results of the treadmill test. Recovery will be determined using a 3-step approach: 1. Self-reported symptoms, 2. Clinic physician's opinion, 3. Treadmill test results (if applicable).
Interventions
BEHAVIORALExercise Prescription
A specific exercise prescription, based on the results of a treadmill test.
BEHAVIORALTreadmill Test
A symptom-limited treadmill test, using the Buffalo Concussion Treadmill Test (BCTT) protocol.
DEVICEMonitoring
Activity monitoring using a Fitbit.
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The primary outcome (recovery) is determined using a 3 step approach. Each assessor responsible for one of the three steps, will be blind to at least ONE other recovery determinant.
Eligibility
Sex/Gender
ALL
Age
17 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Patients that provide written informed consent prior to entry into the study * Patients referred from the emergency department (ED) with recent (\<1 week) diagnosis of concussion by ED physician * GCS score of 13-15 on presentation to the ED * SCAT score \> 9 at week 1 * Physician cleared for exercise; low risk for cardiac disease (defined as no cardiopulmonary symptoms and meet no more than one risk factor for heart disease) * Willing to exercise
Exclusion criteria
* Evidence of intracranial hemorrhage, contusion or injury on brain imaging (CT Scan) * Beta-blocker medication * High dose (\>50mg/day) tricyclic antidepressant medication * Pre-existing or current orthopedic injuries preventing exercise * Pre-existing vestibular disease preventing exercise * Heartrate increase \<30 bpm from rest on treadmill test * Deemed asymptomatic from concussion by clinic physician * Unable/unwilling to follow commands
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Recovered | Assessed at week 8 post-concussion. | Recovery (yes/no) will be determined using a 3-step approach: 1. Self-reported symptoms (using the Sport Concussion Assessment Tool \[SCAT\], Symptom Inventory), 2. Clinic physician's opinion, 3. Treadmill test results (if applicable). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Recovered | Assessed at week 2 post-concussion. | — |
| Percentage of Participants who have Returned to Work/School | Assessed at week 2 post-concussion. | Time at which participants return to part-time and/or full-time work or school activities. |
| Brief Symptom Inventory-18 (BSI-18) Global Severity Index Score | Assessed at week 2 post-concussion. | Measured using the Brief Symptom Inventory (BSI)-18. Global scores, as well as somatization, depression, and anxiety sub-scales will be included. Global scores are calculated by adding up participants self-reported score (0-72), with high scores indicating more psychological distress. These scores are then compared to gender-stratified norms. Sub-scales are scored on a 0-24 scale, again higher scores indicating more psychological distress (sub-scales also compared to gender-stratified norms). |
Countries
Canada
Outcome results
None listed