Psychological and Neuromechanical Recovery After Concussion: Dual-Task Stability and Kinesiophobia from Return to Play to Six Months.

Only 12 of the 37 concussed athletes and 8 of the 17 controls came back for the six-month follow-up, and the authors describe that follow-up group as a convenience sample that may differ from those who did not return. Everyone was tested after already being cleared for return to play, on average 41.7 days after diagnosis, so the study says nothing about the first days and weeks after injury, when other work has found balance problems. The paper gives two different figures for how long after injury the athletes were tested, 41.7 days in the results and about 82 days in the limitations, so the timing of the assessment is unclear. Trials where an athlete touched down or lost the balance position were thrown out and repeated, which the authors say may have removed the very instability that would have separated the groups. Fear of movement was self-reported and the Tampa scale has not been well studied in people with concussion, so it may not measure what it measures in a back-pain population. The force-plate standing and landing tasks may be less sensitive than walking-based dual-task tests, and neither resembles the demands of actual sport. The authors list unmeasured factors such as previous injuries and how much rehabilitation each athlete had, which could have affected both fear and balance. Table 2 reports 36 concussed athletes and 18 controls while the text describes 37 and 17.

The study was supported in part by Major League Soccer. The authors declare no conflicts of interest and state that MLS had no role in the data analysis, interpretation of the results, writing of the manuscript, or the decision to submit it.

Do not read this as showing that high fear of movement causes worse balance, or that adding a mental task to balance testing uncovers problems standard tests miss. No balance measure differed between the concussed and control groups, and none differed between the high- and low-fear groups; the high-fear group's worse scores were a trend, not a significant finding. The study also tested no treatment, so it says nothing about whether screening for fear or treating it helps anyone.