Objective To investigate the effect of physical interventions (subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies) on days to recovery and symptom scores in the management of concussion. Design A systematic review and meta-analysis. Data sources Medline, CINAHL, Embase, SportDiscus, Cochrane library, Scopus and PEDro. Eligibility criteria Randomised controlled trials of participants with concussion that evaluated the effect of subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies on days to recovery/return to activity, symptom scores, balance, gait and/or exercise capacity. Results Twelve trials met the inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions. The trials were of fair to excellent quality on the PEDro scale. Eight trials were included in the quantitative analysis. Subthreshold aerobic exercise had a significant small to moderate effect in improving symptom scores (standardised mean difference (SMD)=0.43, 95% CI 0.18 to 0.67, p=0.001, I2=0%) but not in reducing days to symptom recovery in both acutely concussed individuals and those with persistent symptoms (SMD=0.19, 95% CI −0.54 to 0.93, p=0.61, I2=52%). There was limited evidence for stand-alone cervical, vestibular and oculomotor therapies. Concussed individuals with persistent symptoms (>2 weeks) were approximately 3 times more likely to have returned to sport by 8 weeks (relative risk=3.29, 95% CI 0.30 to 35.69, p=0.33, I2=83%) if they received individually tailored, presentation-specific multimodal interventions (cervical, vestibular and oculo-motor therapy). In addition, the multimodal interventions had a moderate effect in improving symptom scores (SMD=0.63, 95% CI 0.11 to 1.15, p=0.02, I2=0%) when compared with control. Conclusions Subthreshold aerobic exercise appears to lower symptom scores but not time to recovery in concussed individuals. Individually tailored multimodal interventions have a worthwhile effect in providing faster return to sport and clinical improvement, specifically in those with persistent symptoms. PROSPERO registration number CRD42020108117.

中文翻译：

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物理干预是否能改善脑震荡后的结果：系统评价和荟萃分析？

目的 研究物理干预（阈下有氧运动、颈椎、前庭和/或动眼神经疗法）对脑震荡管理中恢复天数和症状评分的影响。设计 系统回顾和荟萃分析。数据来源 Medline、CINAHL、Embase、SportDiscus、Cochrane 图书馆、Scopus 和 PEDro。资格标准 脑震荡参与者的随机对照试验，评估阈下有氧运动、颈椎、前庭和/或动眼神经疗法对恢复/恢复活动天数、症状评分、平衡、步态和/或运动能力的影响。结果 12 项试验符合纳入标准：7 项关于阈下有氧运动，1 项关于前庭治疗，1 项关于宫颈治疗，3 项关于个性化定制的多模式干预。在 PEDro 量表上，这些试验的质量从一般到优秀。八项试验被纳入定量分析。阈下有氧运动在改善症状评分方面具有显着的小到中等效果（标准化平均差 (SMD)=0.43, 95% CI 0.18 至 0.67, p=0.001, I2=0%），但在减少症状恢复天数方面没有急性脑震荡个体和持续症状个体（SMD=0.19, 95% CI -0.54 to 0.93, p=0.61, I2=52%）。单独的颈椎、前庭和动眼神经疗法的证据有限。患有持续症状（> 2 周）的脑震荡个体在 8 周内恢复运动的可能性约为 3 倍（相对风险=3.29，95% CI 0.30 至 35.69，p=0.33，I2=83%），如果他们单独接受量身定制的、针对特定表现的多模式干预措施（宫颈、前庭和眼球运动疗法）。此外，与对照组相比，多模式干预在改善症状评分方面具有中等效果（SMD=0.63, 95% CI 0.11 to 1.15, p=0.02, I2=0%）。结论 阈下有氧运动似乎可以降低脑震荡个体的症状评分，但没有时间恢复。个性化定制的多模式干预在提供更快的运动恢复和临床改善方面具有有价值的效果，特别是对于那些有持续症状的人。PROSPERO 注册号 CRD42020108117。结论 阈下有氧运动似乎可以降低脑震荡个体的症状评分，但没有时间恢复。个性化定制的多模式干预在提供更快的运动恢复和临床改善方面具有有价值的效果，特别是对于那些有持续症状的人。PROSPERO 注册号 CRD42020108117。结论 阈下有氧运动似乎可以降低脑震荡个体的症状评分，但没有时间恢复。个性化定制的多模式干预在提供更快的运动恢复和临床改善方面具有有价值的效果，特别是对于那些有持续症状的人。PROSPERO 注册号 CRD42020108117。