Beliefs about the influence of rest during concussion recovery may predict activity and symptom progression within an active duty military population.
Remigo-Baker RA, Gregory E, et. al. Archives PMR. 2020. Epub Ahead of Print.

Take-Home Message

Active duty service members who received education after a concussion had stronger beliefs that rest was important for symptom recovery. A greater belief that rest influenced recovery was related to a better decrease in symptoms over time.


Misconceptions about rest and recovery after a concussion have been documented among athletes. Unfortunately, it is unclear if active duty service members share these beliefs and how early education after a concussion may influences these beliefs and patient outcomes. A better understanding of how beliefs influence activity and symptom progression can influence future educational approaches to optimize patient recovery. Therefore, Remigo-Baker and colleagues studied the relationships between active duty service members’ beliefs about rest after a concussion and change in activity or symptoms over time. They also explored whether these relationships differed among those with or without education after the concussion. The authors completed a secondary analysis of data collected from the Defense and Veterans Brain Injury Center Progressive Return to Activity study. The study included 111 active duty service members (mostly men, ~24 years old) who sustained a concussion within 72 hours of enrollment. Participants completed an initial assessment, which recorded a person’s beliefs of rest influencing recovery, activity level, and symptoms. Participants also indicated if they received verbal or written education for managing concussions. Researchers then conducted follow-up interviews at 1 week, 1 month, 3 months, and 6 months post-injury. Overall, a person who received education (either verbal or written) was more likely to believe that rest influences symptoms recovery. Only among people who received education within 72 hours after a concussion did a greater belief that rest influenced recovery relate to an increase in activity over time. Regardless of education, a greater belief that rest influenced recovery was related to a better decrease in symptoms over time.


Overall, the authors found that a person who received education within the first 72 hours after a concussion may be more likely to believe rest can influence recovery and increase activity over time. The increase in activity over time may indicate that the participants initially rested more and then became more active over the next 6 months. Regardless of education, a stronger belief that rest could influence their recovery was related to a greater decrease in symptoms over time. While we can’t say the education or beliefs caused these outcomes, the authors found evidence to support the need for significant education about the influence rest has on the recovery of symptoms. Future research could build on this by randomizing patients to different education strategies and collecting more details on symptom resolution. Until this research is completed, clinicians should continue to educate their patients about the importance of rest after an injury. The authors noted that an athlete with incorrect beliefs about rest may be less likely to follow recommendations for appropriate timing and dosage of rest, which could lead to undesirable behaviors (e.g., too much early activity, excessive rest for prolonged periods). This reinforces the importance of educating our patients about how rest influences recovery.

Questions for Discussion

How do you educate your patients on the influence of rest and symptom recovery? Based on your patient population, do you feel the results of this study support what you see in your clinical practice?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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