Background:

Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed.

Purpose:

To examine whether training medical providers on the Defense and Veterans Brain Injury Center’s Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory.

Results:

The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury (d = 0.22; 95% CI, –2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week (d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month (d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury (d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months (d = 0.35; 95% CI, 5.34 to 7.59).

Conclusion:

Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.

中文翻译：

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对于现役军人，脑震荡后使用渐进式重返活动指南可能会加快症状缓解。

背景：

脑震荡治疗的临床建议鼓励受伤后立即减少认知和身体活动，并随着症状的缓解逐渐增加活动。需要对此类建议的有效性提供经验支持。

目的：

检查国防和退伍军人脑损伤中心针对急性脑震荡的渐进式活动临床推荐（PRA-CR）培训医疗服务提供者是否可以改善患者的预后。

学习规划：

队列研究；证据水平2。

方法：

该研究于2016年至2018年进行，比较了医疗提供者接受教育干预（即提供者培训）前后的患者预后。在脑震荡后≤72小时，1周，1个月，3个月和6个月时对在介入之前或之后招募的患者进行评估。参与者包括38名军事医学提供者和106名经诊断为脑震荡并由其中一名军事医学提供者治疗的军事服务人员：58名患者参与者在干预之前得到了护理（即，提供者培训），48名参与者在干预之后得到了护理。主要结果指标是神经行为症状清单。

结果：

干预前后所见的患者主要为男性（分别为平均年龄±SD，26.62±6.29岁和25.08±6.85岁）的军人年龄（分别为89.7％和93.8％），平均±SD为1.92±0.88天受伤 与干预前接受治疗的患者相比，干预后接受干预的患者在第一阶段的身体活动（平均变化差异； 95％CI，0.39至6.79）和前庭/平衡活动（95％CI，0.79至7.5）的增加较小。恢复一周。尽管各组在≤72小时的损伤后症状无差异（d = 0.22； 95％CI，–2.21至8.07），但干预后组在1周时的症状较少（d= 0.61; 95％CI，0.52至10.92）。完成6个月研究的干预后患者在受伤后1个月（d = 1.55; 95％CI，5.33至15.39）和伤后3个月（d = 1.10; 95％CI，2.36至11.55）都有改善的康复，但没有在6个月时（d = 0.35； 95％CI，5.34至7.59）。

结论：

对PRA-CR进行医疗服务人员培训以治疗脑震荡可加快患者的康复速度。