Effect of Screen Time on Recovery From ConcussionA Randomized Clinical Trial
Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, Babu KM, Mannix R. A JAMA Pediatr. 2021 Sep 7:e212782. doi: 10.1001/jamapediatrics.2021.2782. Epub ahead of print.
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People who avoided screen time during the first 48 hours after their concussion recovered faster than people permitted screen time.
A brief period of physical and cognitive rest following a concussion is beneficial. However, extended periods of cognitive rest may lead to prolonged symptom recovery. It remains unclear if recommending limited screen time during an acute rest period can influence concussion recovery.
Macnow and colleagues conducted a randomized clinical trial to determine whether screen time during the first 48 hours after a concussion influences the duration of concussive symptoms.
The authors recruited 125 patients (49% female, 12 to 25 years of age) seen in an emergency room within 24 hours of a concussion. They then randomized the participants into 2 groups. One group was permitted screen time within the first 48 hours of recovery (66 people). Meanwhile, the other group received instructions to abstain from screen time for the first 48 hours (59 people). All participants received advice to avoid work /school (in-person and remote) for the first 48 hours. Participants completed the Post-Concussion Sign and Symptoms scale (PCSS) at enrollment and then daily for 10 days. On days 4-10, participants also completed an activity survey. Days until concussion symptoms recovery was defined as a PCSS score of < 3 points.
People permitted screen time averaged ~630 minutes of screen time (mostly a television or phone). In contrast, those advised against screen time reported ~130 minutes of screen time (mostly a phone). The authors found that people who engaged in screen time within 48 hours of a concussion took ~8 days (median) to recovery compared to only 3.5 days among those that refrained from screen time.
Overall, the authors provide evidence that we should advise patients to refrain from screen time during the first 48 hours after a concussion to increase their chance of a faster recovery. It may also be beneficial to remind a patient that this restriction includes limiting the use of a phone. It would be interesting to evaluate how recovery is affected by other common factors associated with symptom provocation, such as riding/driving a car, caffeine/diet, sleep, or lights/noise.
Rest has always been a foundation of acute concussion management. However, the specific instructions on what constitutes cognitive rest have not been well established. Clinicians should consider concussion management strategies that support symptom resolution, such as reducing screen time within the first 48 hours.
Questions for Discussion
Do you instruct your athlete to decrease screen time following a concussion? What kind of instructions do you provide to your athlete following a concussion?
1. Beliefs Become Reality: A Patient’s Beliefs about Rest May Influence Their Concussion Recovery
2. How Much Rest in Between Soccer Matches is Beneficial to Prevent Injuries?
3. No Strict Rest for the Weary or Concussed
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban