An experimental study of two forms of concussion advice on planned physical activity

Abstract

AbstractBackground and aimsBest practice management for medically cleared concussion is to commence a graded return to activity, as tolerated, and within 24–48 h of the injury. Patients may encounter this or other advice if they search the Internet, or when they are discharged from care. It is not yet known how patients would interpret this advice, particularly for specific activities. This study compared the effect of two forms of concussion advice on physical activity plans. It was expected that compared to the advice to gradually return to activity, the advice to ‘rest’ would lead to reduced activity plans.MethodsConcussion simulators received the generic advice to undertake 1 week of (i) rest (no physical activity [NPA], n = 115) or (ii) graded physical activity (GPA, n = 104). Activity plans were recorded using items from the Mild Traumatic Brain Injury Rest-Activity Questionnaire (MTBI-RAQ).ResultsThere was a significant group difference in activity plans (NPA < GPA, total score and for all MTBI-RAQ items, p’s ≤ 0.001, medium-to-large effects). The average NPA response was for a significant reduction from pre-injury for 14 activities, with no planned change for 2 activities (walking, household chores). In the GPA group, there were plans to reduce (nitems = 7), continue (nitems = 5) or increase activities (nitems = 4; e.g., swimming). Both groups proposed to decrease ‘high-risk’ activities (e.g., heavy lifting).ConclusionAs expected, there was a significant effect of the type of advice on physical activity plans. Compared to the GPA advice, the NPA advice led to a significant reduction of planned physical activity. If concussed patients seek or receive advice that recommends NPA, it may prompt activity plans that are unnecessarily restrictive. If GPA advice is given, it leads to varied plans, with fewer restrictions overall, and avoidance of higher risk physical activities. Generic GPA advice has the potential to facilitate active recovery for concussion; however, patients would still likely benefit from a professional consultation about their plan and support to safely implement it, and this should be investigated in future research.