A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

Catherine E Varner; Cameron Thompson; Kerstin de Wit; Bjug Borgundvaag; Reaves Houston; Shelley McLeod

doi:10.1111/acem.14215

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

Acad Emerg Med. 2021 May;28(5):493-501. doi: 10.1111/acem.14215. Epub 2021 Feb 28.

Authors

Catherine E Varner^{1

2}, Cameron Thompson¹, Kerstin de Wit³, Bjug Borgundvaag^{1

2}, Reaves Houston¹, Shelley McLeod^{1

2}

Affiliations

¹ Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada.
² Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

PMID: 33481332
DOI: 10.1111/acem.14215

Abstract

Background: There is a paucity of effective management strategies to prevent prolonged symptoms following mild traumatic brain injury (mTBI), and emerging evidence suggesting possible benefits of exercise. The objective of this trial was to determine whether adult patients presenting to the emergency department (ED) with a diagnosis of acute mTBI prescribed light exercise were less likely to develop persistent postconcussion symptoms (PCS).

Methods: This was a randomized controlled trial conducted in three Canadian EDs. Consecutive, adult (18-64 years) ED patients with an mTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise, and the control group was given standard mTBI instructions advising gradual return to exercise following symptom resolution. The primary outcome was the proportion of patients with PCS at 30 days, defined as the presence of three or more symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ).

Results: A total of 367 patients were enrolled (control group, n = 184; intervention, n = 183). Median age was 32 years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30 days (control, 13.4% vs intervention, 14.6%; ∆1.2%, 95% confidence interval [CI] = -6.2 to 8.5). There were no differences in median change of RPQ scores, median number of return health care provider visits, median number of missed school or work days, or unplanned return ED visits within 30 days. Participants in the control group reported fewer minutes of light exercise at 7 days (30 vs 35; ∆5, 95% CI = 2 to 15).

Conclusion: In this trial of prescribed early light exercise for acute mTBI, there were no differences in recovery or health care utilization outcomes. Results suggest that early light exercise may be encouraged as tolerated at ED discharge following mTBI, but this guidance is not sufficient to prevent PCS.

Trial registration: ClinicalTrials.gov NCT03084211.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain Concussion* / therapy
Canada
Emergency Service, Hospital
Female
Humans
Male
Patient Discharge
Post-Concussion Syndrome* / diagnosis
Post-Concussion Syndrome* / therapy

Associated data

ClinicalTrials.gov/NCT03084211