{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T03:34:43Z","timestamp":1794627283878,"version":"4.9.1"},"reference-count":32,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2021,9,21]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the effect of physical interventions (subthreshold aerobic exercise, cervical, vestibular and\/or oculomotor therapies) on days to recovery and symptom scores in the management of concussion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A systematic review and meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Medline, CINAHL, Embase, SportDiscus, Cochrane library, Scopus and PEDro.<\/jats:p><\/jats:sec><jats:sec><jats:title>Eligibility criteria<\/jats:title><jats:p>Randomised controlled trials of participants with concussion that evaluated the effect of subthreshold aerobic exercise, cervical, vestibular and\/or oculomotor therapies on days to recovery\/return to activity, symptom scores, balance, gait and\/or exercise capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve trials met the inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions. The trials were of fair to excellent quality on the PEDro scale. Eight trials were included in the quantitative analysis. Subthreshold aerobic exercise had a significant small to moderate effect in improving symptom scores (standardised mean difference (SMD)=0.43, 95%\u2009CI 0.18 to 0.67, p=0.001, I<jats:sup>2<\/jats:sup>=0%) but not in reducing days to symptom recovery in both acutely concussed individuals and those with persistent symptoms (SMD=0.19, 95%\u2009CI \u22120.54 to 0.93, p=0.61, I<jats:sup>2<\/jats:sup>=52%). There was limited evidence for stand-alone cervical, vestibular and oculomotor therapies. Concussed individuals with persistent symptoms (&gt;2 weeks) were approximately 3 times more likely to have returned to sport by 8 weeks (relative risk=3.29, 95%\u2009CI 0.30 to 35.69, p=0.33, I<jats:sup>2<\/jats:sup>=83%) if they received individually tailored, presentation-specific multimodal interventions (cervical, vestibular and oculo-motor therapy). In addition, the multimodal interventions had a moderate effect in improving symptom scores (SMD=0.63, 95%\u2009CI 0.11 to 1.15, p=0.02, I<jats:sup>2<\/jats:sup>=0%) when compared with control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Subthreshold aerobic exercise appears to lower symptom scores but not time to recovery in concussed individuals. Individually tailored multimodal interventions have a worthwhile effect in providing faster return to sport and clinical improvement, specifically in those with persistent symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>CRD42020108117.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2020-103470","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T18:49:06Z","timestamp":1633027746000},"page":"292-298","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis?"],"prefix":"10.1136","volume":"56","author":[{"given":"Susan A","family":"Reid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Farbenblum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-4133","authenticated-orcid":false,"given":"Shreya","family":"McLeod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"key":"2024101322051942000_56.5.292.1","doi-asserted-by":"crossref","unstructured":"Baldwin GT , Breiding MJ , Comstock RD . 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