4.5 Pediatric concussion assessment of rest and exertion (PedCARE): a multicentre randomized clinical trial

<h3>Objective</h3> Investigate whether non-contact physical activity at 72-hours post-acute concussion reduces symptoms at two weeks compared to resting until asymptomatic. <h3>Design</h3> Multicentre blinded randomized clinical trial. <h3>Setting</h3> Three pediatric Emergency Departments (ED). <h3>Participants</h3> Participants aged 10–17 years with acute (&lt; 48 hours) concussion. <h3>Intervention</h3> Participants were randomly assigned to initiate a 4-week stepwise return-to-physical activity at 72-hours post-concussion even if symptomatic [Early Group (EG) protocol] or return-to-physical activity once asymptomatic [Rest Group (RG) protocol]. <h3>Outcome Measures</h3> Self-reported post-concussion symptoms at 2-weeks on the Health and Behaviour Inventory (HBI), a validated and reliable 20-item questionnaire. Adverse events were defined as symptoms resulting in an unscheduled ED-visit. Accelerometers were worn 24-hours/day for 14 days post-injury. Group differences and post-concussion symptoms were examined by linear univariable and multivariable analyses adjusting for site and prognostically important covariates. Missing data were imputed. <h3>Results</h3> A total of 456 randomized participants [EG: N=227; median age=13.2(IQR:11.5,14.7); 44.5% female]; [RG: N=229; median age =13.0(IQR:11.6,14.9); 43.7% female] were included in the analyses. No adverse events were reported for either group. EG participants had a median symptom load at 2-weeks of 14.00(IQR: 4.00,22.25) compared to RG participants 16.00(IQR: 7.00,24.00). No strong evidence of an association between early return to physical activity and post-concussion symptoms at 2-weeks was found in univariable [mean difference=-1.2(95%CI:-3.6,1.2] or multivariable analyses [mean difference = -1.0(95%CI:-3.4,1.4]. <h3>Conclusion</h3> Among youth with acute concussion, compared to rest until asymptomatic, physical activity initiation at 72-hours post-injury, was safe and did not provoke post-concussion symptoms at 2-weeks. This abstract has been published in full manuscript format and has the following citation: BMJ Citation https://bjsm.bmj.com/content/early/2021/11/25/bjsports-2021-105030