Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial.
Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial.
复制标题
在患有急性脑震荡的青少年中实施主动损伤管理（AIM）：一项随机对照试验。
DOI：
10.1016/j.cct.2022.106965
复制
发表时间：
2022
影响因子：
2.2
通讯作者：
Kontos,AP
中科院分区：
文献类型：
--
作者：
Thomas,DG;Erpenbach,H;Hickey,RW;Waltzman,D;Haarbauer-Krupa,J;Nelson,LD;Patterson,CG;McCrea,MA;Collins,MW;Kontos,AP
背景在美国，每年有大约200万年轻人在脑震荡后寻求急性医疗护理。目前的护理标准建议脑震荡后的前48小时休息。然而，研究表明，延长休息时间可能会延长康复时间，特别是对于具有特定风险特征的患者。研究表明，体力活动和行为管理干预(睡眠、压力管理)可能会促进恢复。目的确定青少年急性脑震荡的体力活动和行为管理的有效性，并评价患者特征在治疗反应中的作用。方法本多中心前瞻性随机对照试验将确定在受伤后72小时内到急诊科或脑震荡诊所就诊的11-24岁的患者，哪种体力活动和行为管理的组合最有效。参与者被随机分为：1)休息，2)体力活动，3)移动健康应用(MHealth)行为管理，或4)体力活动和mHealth应用条件。登记时、3-5天、14天、1个月和2个月的评估包括：脑震荡症状、平衡、前庭-眼睛和认知评估、生活质量和恢复时间。在注册时对躯体症状和其他危险因素进行评估。每天使用活动仪和每日自我报告评估治疗依从性和症状。主要研究结果是14天后的症状。结论预先描述的体力活动和行为管理可能会改善青年急性脑震荡后的预后。
BackgroundNearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents.ObjectiveTo determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response.MethodsThis multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11–24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3–5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days.ConclusionPrescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.