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A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury
Varner CE, Thompson C, de Wit K, Borgundvaag B, Houston R, McLeod S
Academic Emergency Medicine 2021 May;28(5):493-501
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: There is a paucity of effective management strategies to prevent prolonged symptoms following mild traumatic brain injury (mTBI) and emerging evidence suggesting possible benefits of exercise. The objective of this trial was to determine if adult patients presenting to the emergency department (ED) with a diagnosis of acute mTBI prescribed light exercise were less likely to develop persistent post-concussion symptoms (PCS). METHODS: This was a randomized controlled trial conducted in three Canadian EDs. Consecutive, adult (18 to 64 years) ED patients with an mTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise, and the control group was given standard mTBI instructions advising gradual return to exercise following symptom resolution. The primary outcome was the proportion of patients with PCS at 30 days, defined as the presence of >= 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ). RESULTS: 367 patients were enrolled (control group, n = 184; intervention, n = 183). Median age was 32 years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30 days (control, 13.4% versus intervention, 14.6%; 1.2%, 95% CI -6.2 to 8.5). There were no differences in median change of RPQ scores, median number of return health care provider visits, median number of missed school or work days, or unplanned return ED visits within 30 days. Participants in the control group reported fewer minutes of light exercise at 7 days (30 versus 35; 5, 95% CI 2 to 15). CONCLUSION: In this trial of prescribed early light exercise for acute mTBI, there were no differences in recovery or healthcare utilization outcomes. Results suggest early light exercise may be encouraged as tolerated at ED discharge following mTBI, but this guidance is not sufficient to prevent PCS.

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