Exertional Tolerance Assessments After Mild Traumatic Brain Injury: A Systematic Review.
Catherine Quatman-Yates, Anna Bailes, Sara Constand and 4 others
PMID 29277373WHAT IT FOUND
Exertional testing after concussion may be safe and can reveal symptom or heart-rate changes, but no standard treadmill or bike protocol is established.
Use individualized testing and expect temporary symptom flare.
Key findings
01The review found no gold standard protocol for evaluating exertional tolerance after mild traumatic brain injury.
02The 14 included studies varied widely in design, sample characteristics, and exertion testing protocols.
03The review found limited evidence that post-mTBI exertional testing can be safe and useful for identifying residual physiologic impairment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review included 14 studies, and most were case series or case-control comparisons, so the review could not combine them into a single summary result. Study designs, samples, time since injury, exercise modes, workload progressions, and outcome measures varied widely. The search was limited to English-language peer-reviewed outlets and ended July 20, 2017, so relevant newer or non-English work may have been missed. The quality appraisal tool was created by the authors and was aimed at relevance to this review, not at judging each study for its original purpose. Very little reliability and validity testing has been done for these protocols, and the Buffalo Concussion Treadmill Test reliability data came from only 11 participants with mild traumatic brain injury. Many studies did not clearly say whether participants were athletes or non-athletes.
Declared interests
The supplied text does not include an author conflict-of-interest declaration. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that any treadmill or bike test is a validated way to decide when a patient with mild traumatic brain injury can return to activity. The review found no gold standard protocol, the included studies were highly varied, and the only mild traumatic brain injury reliability data for the Buffalo Concussion Treadmill Test came from 11 participants.