TY - JOUR
T1 - Factors Associated With Return-to-Learn Duration After Concussion in US Service Academy Cadets and Midshipmen
AU - Ross, Jeremy D.
AU - Aderman, Michael J.
AU - Roach, Megan H.
AU - Malvasi, Steven R.
AU - Susmarski, Adam
AU - Brodeur, Rachel M.
AU - McGinty, Gerald
AU - Robb, Joel
AU - Jackson, Jon
AU - Broglio, Steven P.
AU - McCrea, Michael A.
AU - McAllister, Thomas W.
AU - Pasquina, Paul F.
AU - Cameron, Kenneth L.
N1 - Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2026
Y1 - 2026
N2 - OBJECTIVE: Patterns of clinical recovery and factors that may influence return to activity after concussion have been well studied; however, data regarding return-to-learn (RTL) duration after concussion and factors that influence this period have not been adequately explored.HYPOTHESIS: We have hypothesized that sport level, sex, concussion history, and initial symptom burden will be associated with RTL duration after concussion.SETTING: The study was conducted at US military service academies.STUDY DESIGN: This was a prospective cohort study.PARTICIPANTS: A total of 1509 service academy cadets (41% female, 20.2 ± 1.48 y, 174.9 ± 10.3 cm, 73.8 ± 14.0 kg) who sustained a concussion during the study period from December 2014 to March 2020 were included.MAIN MEASURES: The primary outcome of interest was time elapsed between an incident injury and self-reported return to normal academic performance. All participants provided baseline demographics, including sex (male, female), sport level (varsity, non-varsity), and concussion history (yes, no). Participants completed standardized concussion assessments at regular time points. Initial symptom burden was collected within 48 hours after injury, and self-reported RTL duration was collected during the unrestricted return-to-activity (URTA) evaluation.RESULTS: On average, RTL duration was faster in men (8.1 ± 11.2 days) than in women (13.6 ± 20.3 days). Univariate models demonstrated that participants with an initial symptom burden ≤6 returned sooner than those endorsing 7-15 symptoms (HR = 0.73, 95% CI = 0.64-0.83, P ≤ .001) and ≥16 symptoms (HR = 0.56, 95% CI = 0.48-0.65, P ≤ .001). Sex (HR = 0.70, 95% CI = 0.62-0.77, P ≤ .001), and sport level (HR = 0.66, 95% CI = 0.59-0.73, P ≤ .001) also contributed to RTL duration in the univariate model. In the multivariable model, participants with an initial symptom burden ≤6 returned 25%-41% sooner than those endorsing 7-15 symptoms (HR = 0.75, 95% CI = 0.65-0.86, P ≤ .001) and ≥16 symptoms (HR = 0.59, 95% CI = 0.51-0.69, P ≤ .001). Sex (HR = 0.71, 95% CI = 0.64-0.80, P ≤ .001) and sport level (HR = 0.75, 95% CI = 0.67-0.85, P < .001) also contributed to RTL duration in the multivariable model.CONCLUSIONS: RTL duration for men, varsity athletes, and individuals with fewer initial symptoms after injury was significantly faster than for women, nonvarsity athletes, and individuals with a greater initial symptom burden.
AB - OBJECTIVE: Patterns of clinical recovery and factors that may influence return to activity after concussion have been well studied; however, data regarding return-to-learn (RTL) duration after concussion and factors that influence this period have not been adequately explored.HYPOTHESIS: We have hypothesized that sport level, sex, concussion history, and initial symptom burden will be associated with RTL duration after concussion.SETTING: The study was conducted at US military service academies.STUDY DESIGN: This was a prospective cohort study.PARTICIPANTS: A total of 1509 service academy cadets (41% female, 20.2 ± 1.48 y, 174.9 ± 10.3 cm, 73.8 ± 14.0 kg) who sustained a concussion during the study period from December 2014 to March 2020 were included.MAIN MEASURES: The primary outcome of interest was time elapsed between an incident injury and self-reported return to normal academic performance. All participants provided baseline demographics, including sex (male, female), sport level (varsity, non-varsity), and concussion history (yes, no). Participants completed standardized concussion assessments at regular time points. Initial symptom burden was collected within 48 hours after injury, and self-reported RTL duration was collected during the unrestricted return-to-activity (URTA) evaluation.RESULTS: On average, RTL duration was faster in men (8.1 ± 11.2 days) than in women (13.6 ± 20.3 days). Univariate models demonstrated that participants with an initial symptom burden ≤6 returned sooner than those endorsing 7-15 symptoms (HR = 0.73, 95% CI = 0.64-0.83, P ≤ .001) and ≥16 symptoms (HR = 0.56, 95% CI = 0.48-0.65, P ≤ .001). Sex (HR = 0.70, 95% CI = 0.62-0.77, P ≤ .001), and sport level (HR = 0.66, 95% CI = 0.59-0.73, P ≤ .001) also contributed to RTL duration in the univariate model. In the multivariable model, participants with an initial symptom burden ≤6 returned 25%-41% sooner than those endorsing 7-15 symptoms (HR = 0.75, 95% CI = 0.65-0.86, P ≤ .001) and ≥16 symptoms (HR = 0.59, 95% CI = 0.51-0.69, P ≤ .001). Sex (HR = 0.71, 95% CI = 0.64-0.80, P ≤ .001) and sport level (HR = 0.75, 95% CI = 0.67-0.85, P < .001) also contributed to RTL duration in the multivariable model.CONCLUSIONS: RTL duration for men, varsity athletes, and individuals with fewer initial symptoms after injury was significantly faster than for women, nonvarsity athletes, and individuals with a greater initial symptom burden.
KW - concussion
KW - military
KW - recovery
KW - return-to-learn
UR - https://www.scopus.com/pages/publications/105035742769
U2 - 10.1097/HTR.0000000000001156
DO - 10.1097/HTR.0000000000001156
M3 - Article
C2 - 41855113
AN - SCOPUS:105035742769
SN - 0885-9701
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
ER -