Is prescribing rest an appropriate treatment for children who are recovering from concussion?
Children who have experienced a concussion should not be placed on bed rest but instead may return to their previous activity level as allowed by the development of new and worsening symptoms. (LOE = 1a-)
Overuse alert: This POEM aligns with Choosing Wisely Canada's patient information: What to Do When Your Child Suffers a Concussion.
These researchers conducted a systematic review of 4 databases and identified 24 English-language studies (including 10 randomized controlled trials) of children to determine the effect of activity on symptoms, quality of life, and return to pre-injury activity levels after a concussion. They followed PRISMA guidelines for conducting and reporting the results. Results from randomized trials were combined for meta-analysis. In 7 studies with a total of 269 participants, symptoms resolution was slightly better in children who returned to normal activity rather prescribed rest (standardized mean difference = 0.39; 95% CI 0.15 - 0.63). Quality of life is not affected by rest versus return to normal activity, and the rate of return to pre-injury activity levels could not be assessed. For study outcomes that could be combined, there was no evidence of heterogeneity among the studies. Risk of bias was high in the randomized controlled studies, mainly because of the lack of masking of the children to their treatment assignment. Publication bias was not reported.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine