Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

OBJECTIVE: To determine the effects of following return to activity (RTA) and return to school (RTS) protocols on clinical outcomes for children with concussion. The 12 subquestions of this review focus on the effectiveness of protocols, guidelines and recommendations, and the evidence supporting content of the protocols including rest, exercise and school accommodations. DESIGN: Systematic review. DATA SOURCES: PubMed, MEDLINE, EMBASE, CINAHL, ERIC and manual reference list check. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they evaluated RTA or RTS protocols in children aged 5-18 years with a concussion or if they reported a rigorous study design that provided evidence for the recommendations. Included studies were original research or systematic reviews. Articles were excluded if they did not report on their methodology or included participants with significant neurological comorbidities. RESULTS: The literature search retrieved 198 non-duplicate articles and a total of 13 articles were included in this review. Despite the adoption of several RTS and RTA protocols in clinical practice there is little evidence to determine their efficacy in the paediatric population. SUMMARY: The current data support the recommendation that children in the acute stage postconcussion should undergo 1-2 days physical and cognitive rest as they initiate graduated RTA/RTS protocols. Prolonged rest may increase reported symptoms and time to recovery. Further interventional studies are needed to evaluate the effectiveness of RTA/RTS protocols in youth with concussion.