A - 21 Relationship Between Time to Exertion Therapy and Medical Clearance Following Concussion

Abstract Purpose To examine the relationship between time to exertion therapy (i.e., cardiovascular, dynamic, and sport-specific exercises based on the patient’s functional demands) and medical clearance in patients post-concussion. Method This study involved a retrospective chart review of patients aged 10–29 years within 0–12 months of a diagnosed concussion and referred to exertion therapy from a specialty clinic. Demographics, medical history, injury characteristics, clinical assessment (e.g., Concussion Clinical Profile Screen [CP Screen]), exertion therapy (e.g., time to referral/initial therapy session, subjective compliance with home exercises), and recovery data (e.g., time to clearance) were extracted. Multiple linear regression (LR) was used to examine the relationship between time to exertion therapy and medical clearance. Results Participants included 81 patients (age = 16.1 ± 3.2 years; Female = 39.5%, SRC = 79.0%). Patients presented 12.1 ± 17.0 days post-injury and completed their initial exertion therapy session 9.60 ± 9.2 days from their initial clinic visit. Multiple LR (F(6,64) = 14.9, p < 0.001, Adj.R2 = 0.54) supported a significant relationship between time to exertion therapy from initial clinic visit (B = 0.75, p < 0.001) with time to medical clearance when controlling for days from injury to initial clinic visit (B = 0.03, p = 0.69) and CP Screen total (B = -0.04, p = 0.72). Anxiety history (B = 8.8, p = 0.01), SRC vs. non-SRC (B = -9.7, p = 0.004), and subjective compliance (B = -8.4, p = 0.003) were also significant predictors of time to medical clearance. Conclusions Delayed time from initial clinic visit to start of exertion therapy was associated with later medical clearance. Anxiety history, non-SRC injury, and non-compliance with exertion exercises were also associated with later medical clearance. Clinicians should initiate exertion therapy as early as possible following initial clinic visit for concussion.