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Neuromuscular training after concussion to improve motor and psychosocial outcomes: a feasibility trial [with consumer summary]
Howell D, Seehusen C, Walker G, Reinking S, Wilson J
Physical Therapy in Sport 2021 Nov;52:132-139
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the feasibility of an 8-week neuromuscular training program initiated upon return-to-play clearance following concussion. DESIGN: Feasibility trial. SETTING: A single sports medicine center. PARTICIPANTS: We approached n = 54 patients; n = 32 agreed to participate (59%). n = 27 participants returned for their second visit at return-to-play clearance (84%) and were randomized to neuromuscular training (n = 13) or standard-of-care (n = 14). MAIN OUTCOME MEASURES: Participants completed three assessments: within 14 days post-concussion, immediately after return-to-play clearance, and 8-weeks following return-to-play clearance. The intervention aimed to achieve positive neuromuscular adaptations and occurred 2x/week for 8 weeks under supervision. RESULTS: n = 2 participants randomized to the intervention elected not to participate, both due to schedule conflicts (eg time required to meet with the study team). Participants began the intervention an average of 11 days after return-to-play clearance, the majority (91%) completed > 75% of training sessions, and training sessions lasted an average of 18.2 +/- 4.8 min. One participant stopped the intervention after 7 training sessions due to time availability. CONCLUSION: It is feasible to initiate a neuromuscular training program for most athletes shortly after returning to play following concussion. Clinicians and researchers may consider this approach to mitigate the increased musculoskeletal injury risk for concussion patients returning to sports.

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