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J Neurol Phys Ther. 2018 Jul;42(3):123-131. doi: 10.1097/NPT.0000000000000227.

An Exploration of the Impact of Initial Timing of Physical Therapy on Safety and Outcomes After Concussion in Adolescents.

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Division of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.L., J.A.H., M.C.S., K.S.N., C.Q.-Y.); Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.A.H., M.C.S., C.Q.-Y.); Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (B.G.K.); The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada (I.G.); and Division of Physical Therapy, The Ohio State University, Columbus (C.Q.-Y.).



Physical therapy (PT) is a management strategy increasingly recognized to facilitate recovery after concussion. The purpose of this study was to investigate the safety and outcomes of multimodal impairment-based PT at varying time points after injury in youth diagnosed with concussion.


Data were extracted retrospectively from medical records for patients who received PT for concussion-related impairments. Patient records were categorized into 3 cohorts on the basis of the timing of PT implementation: 0-20 days following injury (early intervention), 21 to 41 days following injury (middle intervention), and 42 or more days following injury (late intervention). The primary outcome measure was Post-Concussion Symptom Inventory score from the beginning to the end of the PT episode of care. Additional outcome measures included number of PT sessions, duration of PT episode of care (days), and occurrence of unplanned visits to a health care provider.


A total of 120 patient records (mean age of 14.77 years) were analyzed. Thirty-three, 39, and 48 individuals were categorized into the early, middle, and late intervention cohorts, respectively. There were no significant differences between intervention cohorts with regard to symptom change on the Post-Concussion Symptom Inventory from the beginning to the end of the PT episode of care, unplanned health care visits, number of PT sessions, or duration of PT episode of care.


Early initiation of PT may be safe and tolerable. Future prospective studies are needed to explore the efficacy of PT services administered early following injury to help characterize an optimal care plan for youth following concussion.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at:

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