A PILOT STUDY EVALUATING THE TIMINGOF VESTIBULAR THERAPY AFTER SPORT-RELATED CONCUSSION: EARLIER IS BETTER

Abstract

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physiotherapy is important to promote recovery; however, the benefit of earlier therapy is unclear. Purpose: To determine if earlier vestibular therapy for young athletes with sport-related concussion is associated with earlier return-to-play (RTP), return-to-learn (RTL), and symptom resolution. Study Design: Retrospective Cohort Study Methods: Patients ages 5-23 with sport-related concussion who initiated vestibular therapy from 1/2019-12/2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤ 30 days post-injury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients were included (10 early,13 late) aged 16.14±2.98 years and 43.5% male. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110[61.3,150.8] vs. 31[22.5, 74.5], 95% CI-115.0—8.0, p=0.028), but not to RTL (12[3.5,26.5] vs. 17.5[8,20.75], 95%CI -11.0-12.0, p=0.085. Most notably, the late therapy group required more time to achieve symptom resolution (121.5 days [71,222.8] vs. 54 days [27,91] 95%CI -150.0-9.0, p=0.018). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution (HR 0.988, 95%CI 0.98-0.99, p=0.008). Conclusion: This pilot study evaluating vestibular therapy timing suggests that initiating VRT within the first 30 days following SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT to resolve post-concussion syndrome should be pursued. Tables/Figures:Figure 1a/b: Kaplan-Meier analysis with Log Rank of proportion of athletes not RTP (a) and symptomatic athletes (b) stratified by number of days since injury