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.
https://www.archives-pmr.org/article/S0003-9993(20)30170-2/fulltext
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.
Summary
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.
Viewpoints
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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I personally am an ATS, however I try my best to educate my athletes on the influence of rest and the symptoms recovery immediately after the injury occurs by verbally discussing with them along with the ATC that it is important to rest during this recovery phase. Being an athlete myself I have had ATC address my team prior to the session about concussion and recovery information along with supplying written education which I feel is extremely helpful in patient education. Furthermore, I personally have worked with college as well as high school patient populations and I have noticed that the patient education within those 72 hours after a concussion has an impact on the recovery. I feel this has a greater impact on the high school population as they are minors therefore this education normally includes a parent/guardian, thus the parent/guardian will be able to help monitor the patient to make sure they rest in order to recovery from their concussion. In my opinion, ATC could increase their patient education in order to help aid in the recovery of concussions. This education could be meetings with athletes prior to the season and during the sports season, as well as immediate education after the injury, that is both written and verbal.
Meagan,
Thanks for the comment! I have had discussions with many clinicians that pre-season meeting, while usually done yield mixed results in terms of athlete buy-in. Do you have any particular strategies that you have seen that you feel made an impact on your athletes?
Thanks again,
Kyle
In my experience as an ATS, my preceptors have been very clear with concussion education post injury especially emphasizing the importance of rest in the healing process. There is also some education given to athletes when preforming baseline concussion testing but not very much. As an athlete, I have had teammates who did not listen to the instructions to rest or did not think that they needed to rest and their recovery took a long time. Believing that rest is an important part of recovering from a concussion will help the recovery. It is a psychological effect, similar to if a patient believes a certain modality works for them during treatment, it will work and if they believe it does not work, it will influence what they get out of the treatment. Possibly increasing the amount of concussion education to more than just post-injury and minimal during baseline testing would help. Incorporating pre-season meetings with sports teams as well as greater education during baseline testing could be beneficial in emphasizing the importance of rest in post-concussion recovery.
Infinity,
Great comment, thank you! I agree that clinicians need to continue to be innovative with regards to concussion education. Are there other strategies that you have seen employed which other clinicians may find helpful?
Thanks again,
Kyle
I am an athletic training student, when I talk to my athletes about concussions and treatment/rest I try to level with them being an athlete myself. I tell them how I understand that no one wants to sit out, but it is more important to sit and rest not rather than return to play too early. I think it is very important to educate our patients early about rest and recovery for concussions. Education should occur prior to every sports season at the very least, and possibly even multiple times a year. I believe that the more our patients are educated on this topic the better compliance we will have as clinicians in the recovery of these injuries.
Calvin,
Thanks for the comment. I think personal experience is always helpful when discussing treatments with athletes. While education is certainly important, I am interested in any more specific strategies that you’ve encountered which have helped with compliance of a treatment program which included rest. Have you seen or learned of any strategies which may be helpful here?
Thanks,
Kyle