On October 4, AAPM&R released a new consensus statement for the treatment of concussion and mild traumatic brain injury. This statement, An Evidence-Based Review of Exercise, Rehabilitation, Rest and Return to Activity Protocols for the Treatment of Concussion and Mild Traumatic Brain Injury, is now available on the PM&R Journal website.
This statement is the culmination of work led by AAPM&R starting with a think tank in 2016, followed by the 2018 convening of a multispecialty expert physician panel to review current literature and develop consensus recommendations.
Why is this guidance needed?
Early diagnosis and appropriate management of concussion/mild traumatic brain injury (mTBI) is critical for preventing poor outcomes and minimizing healthcare burden. However, the current clinical guidelines for concussion management focus mostly on diagnosis and return to cognitive and physical activity and provide limited guidance on the use of specific therapeutic interventions. To address this discrepancy, AAPM&R led a multispecialty expert physician panel to explore and evaluate the management of concussion/mTBI interventions including rest, exercise, rehabilitation and return to activity (RTA) protocols.
Key findings from this study include:
- Exercise was recommended as an appropriate therapy for acute concussion in adolescents.
- The evidence on other therapeutic interventions for concussion/mTBI remains limited to small randomized controlled trials and observational studies of moderate to low quality.
- There is no strong evidence to support or recommend against the other evaluated interventions but found most interventions to be safe when used judiciously and in consideration of individual patient needs.
- High-quality randomized studies with sufficient power are needed to evaluate the effects of rest, rehabilitation and RTA protocols for the management of concussion/mTBI.
AAPM&R’s leadership worked closely with several medical specialty societies to develop this important guidance, including: American Academy of Family Physicians, American Academy of Neurology, American Association of Neurological Surgeons, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine and American Orthopaedic Society for Sports Medicine. Thank you to these organizations for their collaboration!
Thank you to our Concussion Writing Panel participants:
- Arthur J. De Luigi, MD, FAAPMR (AAPM&R, Panel Chair)
- Kathleen Bell, MD, FAAPMR (AAPM&R)
- J.P. Bramhall, MD (American Orthopaedic Society for Sports Medicine)
- Meeryo Choe, MD (American Academy of Neurology)
- Katherine Dec, MD, FAAPMR (American Medical Society for Sports Medicine)
- Jonathan Finnoff, DO, FAAPMR (AAPM&R)
- Mark Halstead, MD (American Academy of Pediatrics)
- Stanley Herring, MD, FAAPMR (AAPM&R and American College of Sports Medicine)
- Jason Matuszak, MD (American Academy of Family Physicians)
- Patricia Raksin, MD (American Association of Neurological Surgeons)
- Medical Writer: Jennifer Swanson
- Carolyn Millett, AAPM&R Director, Reimbursement & Regulatory Affairs