Effects of Vestibular Rehabilitation and Routine Physical Therapy in Athletes With Post Concussion Syndrome (PCS BESS IPRRS)

Effects of Vestibular Rehabilitation in Comparison With Routine Physical Therapy on Stability, Kinesiophobia and Return to Sports in Athletes With Post Concussion Syndrome

This randomized controlled trial with a parallel design was conducted over six months at Ghurki Trust Teaching Hospital to compare the effects of Vestibular Rehabilitation and Routine Physical Therapy on stability, kinesiophobia, and return to sports in athletes with post-concussion syndrome. A total of 34 participants aged 12 to 30 years were enrolled based on specific diagnostic criteria. Non probability convenient sampling was used, followed by random allocation into experimental and control groups through computer generated sequencing and sealed envelope concealment. Single blinding was done, with participants unaware of their assigned intervention.

The experimental group received a Vestibular Rehabilitation program consisting of balance training, habituation exercises, and gaze stabilization, while the control group underwent Routine Physical Therapy involving ankle strategies and elliptical training. Both interventions were administered for 30 minutes, three times per week, over four weeks. Outcomes were measured pre- and post-intervention using validated tools: the Balance Error Scoring System (BESS) for postural stability, the Urdu version of the Tampa Scale of Kinesiophobia (TSK), and the Injury Psychological Readiness to Return to Sport Scale (I-PRRS). Data analysis was performed using SPSS version 26, employing appropriate parametric or non-parametric tests based on normality, with significance set at p < 0.05. Ethical approval was obtained, informed consent was secured, and all procedures adhered to established ethical standards.

Study Overview

• Status: Not yet recruiting
• Conditions: Post Concussion Syndrome
• Intervention / Treatment: Other: Intervention 1; Other: Control Arm (Conventional Therapy)

• Study Type: Interventional
• Enrollment (Estimated): 34
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tariq Shafi, Post graduation; Phone Number: 03454190056; Email: muhammad.tariq@ubas.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 12 to 30 years
2. Fulfil the criteria of post concussion syndrome as highlighted by Tator et al.(2016)which requires presence of at least 3 or more persistent symptoms from standardized list
3. Sustained a mTBI in past 3 to 12 weeks
4. Having ongoing symptoms from list in PCSS that started 72 hrs or less after an impact
5. Exhibit objective deficits on standardized baseline examination enabling vestibular and ocular dysfunction

Exclusion Criteria:

• Have a chronic infectious disease.

  • Uncontrolled hypertension.
  • Other neurological disorders (not attributed to their primary diagnosis).
  • Cancer treatment (other than basal cell carcinoma), craniotomy, or refractory subdural hematoma.
  • Those on long term use of psychoactive drugs that compromise their ability to perform study activities
  • Those with pacemakers or elevated cardiovascular risk.
  • Ongoing litigation surrounding their injury.
  • Have been diagnosed with a severe brain injury prior to enrollment, or their post concussive symptoms have persisted beyond 12

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vestibular Rehabilitation; The experimental group received a structured Vestibular Rehabilitation Program that included balance training, habituation exercises, and gaze stabilization exercises. These interventions were designed to improve postural stability, reduce dizziness and motion sensitivity, and enhance visual vestibular interaction. Each session lasted 30 minutes, was conducted three times per week, and continued for a total of four weeks under the supervision of a licensed physical therapist.	Other: Intervention 1; Vestibular Rehabilitation includes balance training, habituation exercises, and gaze stabilization/oculomotor training. Balance training is performed 3 times per week, with intensity progressed from static stance to dynamic tasks such as foam beam and head turns. The time is three sets each for 30 seconds, making a total treatment time of 30 minutes. The type of balance training includes static balance (single-leg and tandem) and dynamic balance (foam beam walking with head turns). Habituation exercises were performed three times per week, with intensity of three sets of 100 feet distance covered while gradually increasing complexity from head turns to ball toss. The time is 3 minute activity performed following 1 minute rest, making a total treatment time of 30 minutes. The type of exercise includes VOR habituation such as head turn with ambulation, ball toss up and down while walking, and ball toss side to side while walking. Gaze stabilization/oculomotor training is also performed t
Active Comparator: Routine Physical Therapy; The control group received Routine Physical Therapy, consisting of ankle strategy exercises to improve postural control through ankle musculature and coordination, along with elliptical training at sub-symptom threshold levels to promote aerobic conditioning. Similar to the experimental group, these sessions were performed for 30 minutes, three times per week, for four weeks, and were supervised by a licensed physical therapist.	Other: Control Arm (Conventional Therapy); Routine Physical Therapy consist of ankle strategies and elliptical training. Ankle strategies are performed three times per week with intensity progressed from rocker board to dual-task activities. The time duration is three sets of two minutes with two minutes of rest, resulting in a total treatment time of 30 minutes. The type of exercise involves rocker board movements in anterior/posterior and medial/lateral directions, with or without ball toss or gaze fixation (X1 viewing). Elliptical training is also performed three times per week at mild exertion, starting at level 1 and with asymptomatic threshold. Each session includes a 5-minute warm-up, 20 minutes of training, and a 5-minute cool-down, making the total treatment time 30 minutes. The mode of exercise is submaximal aerobic exercise on an elliptical trainer

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinesiophobia	For kinesiophobia the Urdu version of Tampa scale was used to asses athletes. The Urdu version of the TSK is considered to be a valid and reliable tool for assessing kinesiophobia.; = strongly disagree; = disagree; = agree; = strongly agree Tampa Scale for Kinesiophobia (TSK) The TSK is a self report questionnaire used to measure fear of movement. It contains 17 items, each scored on a 4-point Likert scale: Total score range: 17 to 68 Reverse scored items: 4, 8, 12, 16 (For these items: 1↔4, 2↔3)	4 weeks
Stability	The Balance Error Scoring System (BESS) has demonstrated excellent validity and reliability in patients. Test-retest reliability was strong, with ICC values ranging from 0.88 to 0.99 (average 0.90) and Cronbach's alpha between 0.90 and 0.99, indicating high internal consistency.Types of Errors Hands lifted off the iliac crest Opening eyes Step, stumble, or fall Moving hip into >30° abduction Lifting forefoot or heel Remaining out of the test position for more than 5 seconds The BESS is calculated by adding one error point for each error during the six 20-second tests. Which Foot Was Tested; Left; Right (i.e., the non-dominant foot) Score Card (Number of Errors) Test Condition Firm Surface Foam Surface Double-Leg Stance (feet together) Single-Leg Stance (non-dominant foot) Tandem Stance (non-dominant foot in back) Total Scores: BESS Total:60	4 weeks
Return to sports	The Injury Psychological Readiness to Return to Sport (I-PRRS) scale was selected as it has undergone translation and validation in Dutch athletes. The instrument demonstrated strong internal consistency (Cronbach's α = 0.94) and excellent test-retest reliability (ICC = 0.89). 0 = no confidence at all, 50 = moderate confidence, 100 = complete confidence. Rate Value My overall confidence to play is ________ My confidence to play without pain is ________ My confidence to give 100 percent effort is ________ My confidence to not concentrate on the injury is ________ My confidence in the injured body part to handle the demands of the situation is ________ My confidence in my skill level/ability is ________ Total: ________	4 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences
• Investigators: Study Chair: Tariq Shafi, Lahore University of Biological And Applied Health Sciences; Principal Investigator: Syeda Farwa Aitbar, DPT, Lahore College of Physical therapy; Principal Investigator: Maheen Mazhar, DPT, Lahore College of Physical therapy; Principal Investigator: Ayesha Naeem Khan, DPT, Lahore College of Physical therapy

Study record dates

Study Major Dates

• Study Start (Estimated): March 22, 2026
• Primary Completion (Estimated): June 22, 2026
• Study Completion (Estimated): July 22, 2026

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 3, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): February 10, 2026
• Last Update Submitted That Met QC Criteria: February 3, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: kinesiophobia; Athletes; stability; vestibular rehabilitation; Post concussion syndrome; return to sports; TAMPA; BESS; IPRRS; RPT
• Additional Relevant MeSH Terms: Nervous System Diseases; Mental Disorders; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds, Nonpenetrating; Phobic Disorders; Anxiety Disorders; Brain Concussion; Kinesiophobia; Post-Concussion Syndrome
• Other Study ID Numbers: DPT/ERB/25; Syeda Farwa Aitbar (Registry Identifier: U1111-1333-2730)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After the publication
• IPD Sharing Time Frame: June 2026-October 2026
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No