Effects of Physiotherapy in Individuals With Persistent Symptoms Following Concussion (PTConc)

Physiotherapy Treatment (Including Vestibular Rehabilitation) Compared to Rest in Individuals With Persistent Symptoms of Dizziness, Neck Pain and/or Headache Following Sport-related Concussion.

The purpose of this study is to determine the effects of a combined physiotherapy treatment (including vestibular rehabilitation and treatment for the cervical spine) in youth and young adults with ongoing symptoms of dizziness, neck pain and headaches following a sport-related concussion.

Study Overview

• Status: Completed
• Conditions: Sport-related Concussion
• Intervention / Treatment: Other: Control postural education, general range of motion and strengthening in addition to the standard of care; Other: Physiotherapy

• Study Type: Interventional
• Enrollment (Actual): 31
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N 1N4
      • Sport Injury Prevention Research Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 30 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of Sport-related concussion as per the Third International Consensus Guidelines
• Persistent symptoms (greater than 10 days) of dizziness, unsteadiness, neck pain and/or headaches reported on the Sport Concussion Assessment Tool 2 (SCAT2)
• Clinical examination findings suggesting vestibular and/or cervical spine involvement

Exclusion Criteria:

• Fracture, other neurological conditions, musculoskeletal injuries (other than the cervical spine) that restrict activity and medications that affect neural adaptation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Physiotherapy; Physiotherapy: including vestibular rehabilitation and multimodal treatment for the cervical spine, once weekly with the study physiotherapist for 8 weeks or until time of medical clearance to return to sport. This group also received the control intervention.	Other: Control postural education, general range of motion and strengthening in addition to the standard of care; Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport.; Other: Physiotherapy; Physiotherapy: including vestibular rehabilitation and multimodal treatment for the cervical spine, once weekly with the study physiotherapist for 8 weeks or until time of medical clearance to return to sport.
Active Comparator: Control; Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport.	Other: Control postural education, general range of motion and strengthening in addition to the standard of care; Control: postural education, general range of motion and strengthening in addition to the standard of care rest followed by graded exertion. Individuals were seen once weekly for eight weeks or until time of medical clearance to return to sport.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Days to medical clearance to return to sport	Number of days to medical clearance by study physician	up to 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Numeric Pain Rating Scale Score-Neck Pain	Self-reported cervical spine pain rated on a scale of 0-10	Change between Baseline and 8 weeks or time of medical clearance
Change in Numeric Dizziness rating Score	Self reported dizziness on a scale of 0-10	Change between Baseline and 8 weeks or time of medical clearance
Change in Numeric Pain Rating Scale Score-Headache	Self-report score for headache on a scale of 0-10	Change between Baseline and 8 weeks or at time of medical clearance
Change in Activities Specific Balance Confidence Scale Score	Self report measure of confidence during 16 balance activities	Change between Baseline and 8 weeks or time of medical clearance
Change in Dizziness Handicap Index Score	Self report measure evaluating perceived handicap secondary to dizziness	Change between Baseline and 8 weeks or time of medical clearance
Change in Sport Concussion Assessment Tool 2 (SCAT2)	Multifaceted tool used in the assessment of concussion and includes domains of symptom report, cognitive function, balance and coordination	Change between Baseline and 8 weeks or time of medical clearance
Change in Dynamic Visual Acuity	Assessed clinically using an eye chart and a metronome set at 2 Hz. Static visual acuity is measured 13 feet from the target. The subjects head is rotated at 2 Hz and visual acuity is measured dynamically. The difference between static and dynamic visual acuity is calculated.	Change between Baseline and 8 weeks or time of medical clearance
Head Thrust Test	Clinical test performed in sitting with head flexed and high velocity low amplitude motion into 5-15 degrees rotation is performed while the subject is asked to maintain focus with the examiner's nose.	Baseline and at 8 weeks or time of medical clearance
Change in modified Motion Sensitivity Test Score	Patient report of intensity and duration of dizziness with eight head or body motions	Change between Baseline and 8 weeks or time of medical clearance
Change in Functional Gait Assessment Score	Dynamic Balance Measure that includes 10 different movements and the ability to complete each activity is rated by the examiner.	Change between Baseline and 8 weeks or time of medical clearance
Change in Cervical Flexor Endurance	Test to evaluate the time (seconds) that an individual can maintain the head in a position of craniovertebral flexion and two finger widths above a pillow in crook lying.	Change between Baseline and 8 weeks or time of medical clearance
Change in Joint Position Error	Clinical test using a laser pointer affixed to a head piece on top of the head that is projected onto a bull's eye target. Subject rotates head to left, right (rotation) or up (extension) to the maximum comfortable range and relocates to the perceived point of neutral head position with eyes closed. A measures from the centre of the bull's eye is recorded. A mean of three trials is recorded for each direction.	Change between Baseline and 8 weeks or time of medical clearance

Collaborators and Investigators

• Sponsor: Sport Injury Prevention Research Centre
• Collaborators: University of British Columbia; University of Calgary; Alberta Centre for Child, Family & Community Research
• Investigators: Principal Investigator: Willem H Meeuwisse, MD, PhD, Sport Injury Prevention Research Centre, University of Calgary; Principal Investigator: Carolyn A Emery, PT, PhD, Sport Injury Prevention Research Centre, University of Calgary; Study Director: Kathryn J Schneider, PT, PhD, Sport Injury Prevention Research Centre, University of Calgary

Publications and helpful links

General Publications

• Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, Emery CA. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014 Sep;48(17):1294-8. doi: 10.1136/bjsports-2013-093267. Epub 2014 May 22.

Study record dates

Study Major Dates

• Study Start: November 1, 2010
• Primary Completion (Actual): December 1, 2011
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: May 20, 2013
• First Submitted That Met QC Criteria: May 22, 2013
• First Posted (Estimate): May 23, 2013

Study Record Updates

• Last Update Posted (Estimate): May 24, 2013
• Last Update Submitted That Met QC Criteria: May 23, 2013
• Last Verified: May 1, 2013

More Information

Terms related to this study

• Keywords: Treatment; Physiotherapy; Dizziness; Neck pain; Headaches; Sport-related concussion
• Additional Relevant MeSH Terms: Neurologic Manifestations; Sensation Disorders; Dizziness
• Other Study ID Numbers: SIPRC-PT-conc-01