Vestibular Rehabilitation as an Early Intervention in Athletes Who are Post-concussion: A Systematic Review.

Only 11 studies were included, six of them randomized trials, and quality was fair to good at best with no study in the excellent range. Nothing is pooled, so no single estimate of effect comes out of this review. Most treatments were combinations of vestibular rehabilitation, balance work, oculomotor exercises and cervical manual therapy, so the contribution of any one component cannot be separated. The review reports two different sets of return-to-play figures for the same trial (8% versus 30% in one section, 73.3% versus 7.1% in another). Both cannot be right, so the exact percentages for that study should be treated with caution. Participants ranged in age from 5 to 30, which spans very different stages of brain development, and the studies used different sports, different levels of concussion severity and different definitions of medical clearance, so they are not directly comparable. Several studies relied on self-report symptom questionnaires, and the quality of each study was rated by consensus of the four researchers rather than by blinded independent assessors. The searches were run at times that were available to the four researchers, and no timeframe for starting balance or gaze-stabilization exercises after injury was established. Effects on return to school were not examined.

The authors declare they have no financial or non-financial conflicts of interest to disclose. The supplied text does not name a funding source.

Do not conclude that vestibular rehabilitation speeds recovery from concussion. The only trial that tested it on its own found no difference from a behavioral control on balance, several of the positive results come from studies where it was given alongside cervical manual therapy and other treatments, the review itself says more data are needed before its effectiveness can be judged, and it reports two different sets of return-to-play figures for the same trial.