The impact of persistent post-concussion symptoms and exercise intolerance on patient-specific functioning after mild traumatic brain injury: a biopsychosocial perspective.
Ingerid Kleffelgård, Lars-Johan Viddal Valaas, Helene Lundgaard Søberg and 7 others
A 12-week aerobic exercise programme added to usual rehabilitation did not improve patient-reported activity limitations beyond what was seen in the control group after mTBI.
Both groups improved over 6 months.
Key findings
1The aerobic exercise group showed no greater improvement in patient-reported activity limitations than the control group at 3 months (adjusted mean difference 0.21) or 6 months (0.30).
2Across both groups combined, mean PSFS scores rose from 3.26 at baseline to 5.41 at 3 months and 6.22 at 6 months on a scale from 0 (unable to perform) to 10 (no difficulty).
3Physical activity and exercise was the most frequently reported limitation (31% of nominated activities), followed by work and education (16%), daily living (15%), social activities (15%), cognition and energy (14%), and sensory-demanding environments (9%).
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What it does not show
Single-centre sample from a university hospital outpatient TBI clinic; about 20% of invited patients were excluded because they did not have exercise intolerance, so the findings apply specifically to the exercise-intolerant subgroup. Participants had a higher mean educational level (17.7 years) than the general Norwegian population, which may limit generalisability to other settings. Both groups received usual multidisciplinary rehabilitation and general physical activity advice, so the null between-group result does not rule out a benefit of exercise in the absence of that background care. The high frequency of physical-activity-related limitations may be inflated by the study context: participants were recruited into an exercise trial and had self-reported symptom exacerbation during physical activity as an inclusion criterion.
Declared interests
No conflicts of interest declared. Funded by the Norwegian Fund for Post-Graduate Training in Physiotherapy (grant 139431).
The easy way to misread this
Do not read the 2-to-3 point improvement in PSFS scores over 6 months as evidence that the aerobic exercise programme caused it. The between-group difference was not significant at either time point (p = 0.60 and p = 0.48), and both groups received usual multidisciplinary rehabilitation plus general physical activity advice, so the improvement cannot be attributed to the structured exercise programme.
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