Objective

To compare the effectiveness of a 4-week precision vestibular rehabilitation intervention compared with a behavioral management control intervention for adolescents with vestibular symptoms/impairment within 21 days of a concussion.

Study design

This study used double-blind, randomized controlled trial design involving adolescent (12-18 years) patients with a diagnosed sport/recreation-related concussion with vestibular symptoms/impairment from a concussion-specialty clinic between October 2018 and February 2020. Eligible participants were randomized in a 1:1 to either a 4-week vestibular intervention group (VESTIB) or a behavioral management control group (CONTROL). CONTROLS (n = 25) were prescribed behavioral management strategies (eg, physical activity, sleep, hydration, nutrition, stress management) and instructed to perform stretching/physical activity (eg, walking, stationary cycle) 30 minutes/day. VESTIB (n = 25) were prescribed precision vestibular rehabilitation exercises and instructed to perform at-home exercises for 30 minutes/day. Primary outcomes were improvement in Vestibular/Ocular Motor Screening vestibular items (ie, horizontal/vertical vestibular-ocular reflex, visual motion sensitivity) at 4 weeks postenrollment.

Results

We screened 310 and enrolled a total of 55 (18%) adolescent patients who were randomized to one of the interventions. Fifty of fifty-five (91%) participants completed all aspects of the study protocol. Participants in VESTIB improved significantly across the intervention period in horizontal (mean difference-1.628; 95% CI [-3.20, −0.06]; P = .04) and vertical (mean difference-2.24; 95% CI [-4.01, −0.48]; P = .01) vestibular-ocular reflex, but not visual motion sensitivity (mean difference-2.03; 95% CI [-4.26, 0.19]) of the Vestibular/Ocular Motor Screening score compared with CONTROLS.

Conclusions

Overall, the vestibular intervention group experienced greater clinical improvements in vestibular symptoms/impairment than controls across the 4-week intervention.

Trial Registration

ClinicalTrials.gov: NCT03555370.

中文翻译：

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青少年脑震荡后精确前庭康复的随机对照试验：初步结果

客观的

比较 4 周精确前庭康复干预与行为管理控制干预对脑震荡 21 天内有前庭症状/障碍的青少年的有效性。

学习规划

本研究采用双盲、随机对照试验设计，涉及 2018 年 10 月至 2020 年 2 月期间在脑震荡专科诊所诊断为运动/娱乐相关脑震荡并伴有前庭症状/障碍的青少年（12-18 岁）患者。以 1:1 的比例随机分配到 4 周前庭干预组 (VESTIB) 或行为管理控制组 (CONTROL)。对照（n = 25）规定了行为管理策略（例如，身体活动、睡眠、水合作用、营养、压力管理）并指示进行拉伸/身体活动（例如，步行、固定周期）30 分钟/天。VESTIB (n = 25) 被规定进行精确的前庭康复锻炼，并被指示在家进行 30 分钟/天的锻炼。

结果

我们筛选了 310 名患者，共招募了 55 名 (18%) 青少年患者，他们被随机分配到其中一项干预措施中。五十五名参与者中有五十名 (91%) 完成了研究方案的所有方面。VESTIB 的参与者在水平（平均差 - 1.628；95% CI [-3.20，-0.06]；P  = .04）和垂直（平均差 - 2.24；95% CI [-4.01，-0.48] ]；P  = .01) 与对照相比，前庭/眼部运动筛查评分的前庭眼部反射，但不是视觉运动敏感性（平均差为 2.03；95% CI [-4.26, 0.19]）。

结论

总体而言，在 4 周的干预中，前庭干预组在前庭症状/损伤方面的临床改善比对照组更大。

试用注册

ClinicalTrials.gov：NCT03555370。