Changes in Physician Recommendations for Early Physical Activity After Pediatric Concussion: A Retrospective Study

Abstract

Objectives: This study aimed to analyze changes in physical activity (PA) recommendations after pediatric concussions and examine the associations of patient and injury characteristics with physicians' PA recommendations. Design: Retrospective observational study. Setting: Concussion clinics associated with a pediatric hospital. Patients: Patients aged 10 to 18 years with a concussion diagnosis, presenting to the concussion clinic within 14 days of the injury were included. A total of 4727 pediatric concussions and corresponding 4727 discharge instructions were analyzed. Independent Variables: The independent variables for our study were time, injury characteristics (eg, mechanism and symptom scores), and patient characteristics (eg, demographics and comorbidities). Main Outcome Measures: Physician PA recommendations. Results: From 2012 to 2019, the proportion of physicians recommending light activity at an initial visit increased from 11.1% to 52.6% (P < 0.05) within 1-week postinjury and from 16.9% to 64.0% during the second week postinjury (P < 0.05). A significantly increased odds of recommending “light activity” (odds ratio [OR] = 1.82, 95% confidence interval [CI], 1.39-2.40) and “noncontact PA” (OR = 2.21, 95% CI, 1.28-2.05), compared with “no activity” within 1-week postinjury, was observed in each consecutive year. In addition, higher symptom scores at the initial visit were associated with lower likelihood of recommending “light activity” or “noncontact PA.” Conclusions: Physician recommendation of early, symptom-limited PA after a pediatric concussion has increased since 2012, which mirrors a shift in acute concussion management. Further research assessing how these PA recommendations may facilitate pediatric concussion recovery is warranted.