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Br J Sports Med. 2019 Feb;53(4):250. doi: 10.1136/bjsports-2017-097853. Epub 2018 Mar 2.

What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review.

Author information

1
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
2
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Division of Pediatric Neuropsychology, Children's National Health System, Rockville, Maryland, USA.

Abstract

OBJECTIVE:

To evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents.

DESIGN:

A systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context.

DATA SOURCES:

MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, ClinicalTrials.gov and Google Advanced.

ELIGIBILITY CRITERIA:

Studies were included if they were original research on RTS following SRC in children aged 5-18 years published in English between 1985 and 2017.

RESULTS:

A total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including: symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%-73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion.

CONCLUSIONS:

Schools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations.

PROSPERO REGISTRATION NUMBER:

CRD42016039184.

KEYWORDS:

adolescent; children; concussion; school; sport

PMID:
29500251
DOI:
10.1136/bjsports-2017-097853
[Indexed for MEDLINE]

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