Clinical examination factors that predict delayed recovery in individuals with concussion
Abstract Background Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A...
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| Format: | Article |
| Language: | English |
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AboutScience Srl
2020-05-01
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| Series: | Archives of Physiotherapy |
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| Online Access: | http://link.springer.com/article/10.1186/s40945-020-00081-z |
| _version_ | 1797288724390739968 |
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| author | Corina Martinez Zachary Christopherson Ashley Lake Heather Myers Jeffrey R. Bytomski Robert J. Butler Chad E. Cook |
| author_facet | Corina Martinez Zachary Christopherson Ashley Lake Heather Myers Jeffrey R. Bytomski Robert J. Butler Chad E. Cook |
| author_sort | Corina Martinez |
| collection | DOAJ |
| description | Abstract Background Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis. Methods The study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR. Results 80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR. Conclusions The clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion. |
| first_indexed | 2024-03-07T18:53:39Z |
| format | Article |
| id | doaj.art-c203ee62776e440f8688b0a403f1c8d0 |
| institution | Directory Open Access Journal |
| issn | 2057-0082 |
| language | English |
| last_indexed | 2024-03-07T18:53:39Z |
| publishDate | 2020-05-01 |
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| record_format | Article |
| series | Archives of Physiotherapy |
| spelling | doaj.art-c203ee62776e440f8688b0a403f1c8d02024-03-02T00:52:56ZengAboutScience SrlArchives of Physiotherapy2057-00822020-05-011011810.1186/s40945-020-00081-zClinical examination factors that predict delayed recovery in individuals with concussionCorina Martinez0Zachary Christopherson1Ashley Lake2Heather Myers3Jeffrey R. Bytomski4Robert J. Butler5Chad E. Cook6Department of Physical Therapy and Occupational Therapy, Duke UniversityDepartment of Physical Therapy and Occupational Therapy, Duke UniversityDepartment of Physical Therapy and Occupational Therapy, Duke UniversityDepartment of Physical Therapy and Occupational Therapy, Duke UniversityDepartment of Orthopedics, Duke UniversitySt Louis CardinalsDivision of Physical Therapy, Department of Orthopedics, Duke UniversityAbstract Background Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis. Methods The study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR. Results 80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR. Conclusions The clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion.http://link.springer.com/article/10.1186/s40945-020-00081-zConcussionPost-concussion syndromeVestibular |
| spellingShingle | Corina Martinez Zachary Christopherson Ashley Lake Heather Myers Jeffrey R. Bytomski Robert J. Butler Chad E. Cook Clinical examination factors that predict delayed recovery in individuals with concussion Archives of Physiotherapy Concussion Post-concussion syndrome Vestibular |
| title | Clinical examination factors that predict delayed recovery in individuals with concussion |
| title_full | Clinical examination factors that predict delayed recovery in individuals with concussion |
| title_fullStr | Clinical examination factors that predict delayed recovery in individuals with concussion |
| title_full_unstemmed | Clinical examination factors that predict delayed recovery in individuals with concussion |
| title_short | Clinical examination factors that predict delayed recovery in individuals with concussion |
| title_sort | clinical examination factors that predict delayed recovery in individuals with concussion |
| topic | Concussion Post-concussion syndrome Vestibular |
| url | http://link.springer.com/article/10.1186/s40945-020-00081-z |
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