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Recovery Following Sport-Related Concussion

Integrating Pre- and Postinjury Factors Into Multidisciplinary Care

Kontos, Anthony P. PhD; Elbin, R. J. PhD; Sufrinko, Alicia PhD; Marchetti, Gregory PhD, PT; Holland, Cyndi L. MPH; Collins, Michael W. PhD

Section Editor(s): Bazarian, Jeffrey J. MD, MPH

The Journal of Head Trauma Rehabilitation: November/December 2019 - Volume 34 - Issue 6 - p 394–401
doi: 10.1097/HTR.0000000000000536
Original Articles

Objective: Update concussion recovery curves by considering pre- and postinjury modifying factors. Determine whether there is a dose-response for modifying factors on recovery.

Setting: Sports medicine concussion clinic.

Participants: A total of 314 athletes aged 12-23 years within 7 days of a concussion enrolled between 2015 and 2018.

Design: Prospective cohort study.

Main Measures: Categorical recovery time defined as days from injury to full medical clearance for return to play per established criteria. Preinjury factors included age, gender, concussion history, and migraine history. Postinjury factors included loss of consciousness, posttraumatic amnesia, posttraumatic migraine symptoms, and high symptom burden.

Results: Average recovery was 27.5 ± 25 days. Five factors were prognostic of recovery: (1) younger than 18 years, (2) female, (3) history of migraine, (4) posttraumatic migraine symptoms, and (5) high symptom burden (P < .05). Recovery percentage at 21 days after injury was 96.7% for participants with 0 factor, 65.3% for those with 1 to 2, and 31.8% for those with 3 to 5—with prognostic separation in low- to high-risk groups of 62%.

Conclusions: Findings support a dose-response for combined pre- and postinjury factors on recovery. Both the type and quantity of modifying factors influence recovery and should be considered in prognosis and approaches to multidisciplinary care.

Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania (Drs Kontos, Sufrinko, and Collins); UPMC Sports Concussion Program, Pittsburgh, Pennsylvania (Drs Kontos, Sufrinko, and Collins and Ms Holland); Department of Health, Human Performance and Recreation/Office of Sports Concussion Research, University of Arkansas, Fayetteville (Dr Elbin); and Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania (Dr Marchetti).

Corresponding Author: Anthony P. Kontos, PhD, UPMC Sports Concussion Program, 3200 South Water St, Pittsburgh, PA 15203 (

Dr Collins is a shareholder of ImPACT Applications, Inc. Drs Kontos and Collins receive royalties from APA Books and research support through the University of Pittsburgh from the National Football League. Dr Elbin receives research support through the University of Arkansas from Brain Scope. None of the other authors have any conflicts of interest to declare.

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.