{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:31:33Z","timestamp":1768437093110,"version":"3.49.0"},"reference-count":25,"publisher":"National Athletic Trainers' Association","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cluster RCT (NCT02988596)<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Sports medicine clinic and field settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients or Other Participants<\/jats:title>\n                  <jats:p>The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US\/Canadian colleges (n = 128) and US high schools (n = 40).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure(s)<\/jats:title>\n                  <jats:p>Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9\/819 MDR + EGE sessions (0.9%) and 1\/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8\/9 resolved to &amp;lt;10 points by the next session. Two study-related AEs (1 in each arm) were reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.4085\/1062-6050-0696.23","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T09:37:35Z","timestamp":1716370655000},"page":"1163-1170","source":"Crossref","is-referenced-by-count":4,"title":["Symptom Exacerbation and Adverse Events During a Randomized Trial of Early-Stage Rehabilitation After Sport-Related Concussion: Safety Outcomes From the Active Rehab Study"],"prefix":"10.4085","volume":"59","author":[{"given":"Johna K.","family":"Register-Mihalik","sequence":"first","affiliation":[{"name":"* Matthew Gfeller Center, Department of Exercise and Sport Science"},{"name":"\u2020 Injury Prevention 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Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Jewell","sequence":"additional","affiliation":[{"name":"*** Department of Kinesiology and Recreation Administration, North Carolina Central University, Durham"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline J.","family":"Ketcham","sequence":"additional","affiliation":[{"name":"\u00b6\u00b6 Department of Exercise Science, Elon University, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline Wesley","family":"Siler","sequence":"additional","affiliation":[{"name":"\u2016\u2016 College of Health Sciences, University of Lynchburg, VA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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