@article{c1f743bdff914b4ab3d26bd268032dac,
title = "Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets",
abstract = "Background: Current consensus and position statements recommend that concussed patients be asymptomatic upon the initiation of the graduated return to activity (RTA) protocol. However, a significant number of concussed patients are beginning their RTA protocols while endorsing symptoms. Purpose: To characterize symptom endorsement at the beginning of the RTA protocol and examine the association between symptom endorsement and RTA protocol duration in service academy cadets. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort study was conducted with cadets at 3 US service academies. Postconcussion symptom inventories were recorded upon the initiation of an RTA protocol. The Sport Concussion Assessment Tool Symptom Inventory was used to classify participants into 3 groups (0 symptoms, 1 symptom, and ≥2 symptoms) upon the initiation of the RTA protocol. The primary outcome of interest was RTA protocol duration. Kaplan-Meier survival estimates were calculated to estimate RTA protocol duration by symptom endorsement, sex, varsity status, academic break, and time to graduated RTA initiation. Univariate and multivariable Cox proportional hazards models were used to estimate the association between symptom endorsement at the initiation of the RTA protocol and RTA protocol duration (α <.05). Results: Data were analyzed from 966 concussed cadets (36% women). Headache (42%) and faintness/dizziness (44%) were the most commonly endorsed symptoms on the Sport Concussion Assessment Tool-Third Edition and the Brief Symptom Inventory-18, respectively. Univariate results revealed a significant association between endorsing ≥2 symptoms and RTA protocol duration. In the multivariable model, endorsing ≥2 symptoms maintained a statistically significant association with RTA protocol duration. Significant associations were observed between RTA protocol duration and nonvarsity status (27% longer), women (15% longer), academic breaks (70% longer), and time to the initiation of the RTA protocol (1.1% longer daily incremental increase) after controlling for covariates. Conclusion: Symptom endorsement at the initiation of an RTA protocol was associated with RTA protocol duration. Cadets who had returned to preinjury baseline symptom burden or improved from baseline symptom burden and endorsed ≥2 symptoms at the initiation of the RTA protocol took longer to RTA.",
keywords = "asymptomatic, concussion, military training, recovery, return to activity",
author = "Aderman, {Michael J.} and Brett, {Benjamin L.} and Malvasi, {Steven R.} and Gerald McGinty and Jackson, {Jonathan C.} and Svoboda, {Steven J.} and Michael McCrea and Broglio, {Steven P.} and McAllister, {Thomas W.} and Pasquina, {Paul F.} and Cameron, {Kenneth L.} and Houston, {Megan N.}",
note = "Funding Information: One or more of the authors has declared the following potential conflict of interest or source of funding: This publication was made possible in part with support from the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded in part by the National Collegiate Athletic Association and the Department of Defense. The U.S. Army Medical Research Acquisition Activity (820 Chandler Street, Fort Detrick, MD 21702-5014) is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the Department of Defense, through the Joint Program Committee 6/Combat Casualty Care Research Program–Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH1420151. S.J.S. has received support for education from Supreme Orthopedic Systems and Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Funding Information: This study was conducted at 3 US service academies: the United States Military Academy, the United States Air Force Academy, and the United States Coast Guard Academy. The authors thank Bonnie Campbell, Lisa Campbell, Megan Jackson, Jennifer Miley, Joel Robb, and Kim Robb (United States Air Force Academy); Robin Miller and Jarrett Headley (United States Coast Guard Academy); Stephanie Carminati, Story Miraldi, Karen Peck, Jamie Reilly, Sean Roach, Jeremy Ross, and Jesse Trump (Unites States Military Academy) for data acquisition. Also, the authors thank the research and medical staff who assisted with baseline data collection at each of the 3 service academies. The authors also express their thanks to Jaroslaw Harezlak, Jody Harland, Janetta Matesan, Larry Riggen (Indiana University); Ashley Rettmann (University of Michigan); Melissa Koschnitzke (Medical College of Wisconsin); Michael Jarrett, Vibeke Brinck, and Bianca Byrne (QuesGen); and Thomas Dompier, Erin B. Wasserman, Milessa Niceley Baker, and Sara Quetant (Datalys Center for Sports Injury Research and Prevention). Publisher Copyright: {\textcopyright} 2022 The Author(s).",
year = "2022",
month = mar,
doi = "10.1177/03635465211067551",
language = "English",
volume = "50",
pages = "823--833",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
number = "3",
}