EFFECTS OF ACUTE POST-CONCUSSION SYMPTOMS ON PROGNOSIS OF OUTCOMES IN ADULTS WITH PCS FOR GREATER THAN SIX MONTHS: A SYSTEMATIC REVIEW
Background: The prolonged effects of concussions are surfacing. While most will fully recover, some will remain with persistent symptoms for months to years and develop post-concussion syndrome (PCS). Physiotherapists are often unaware of how to manage PCS lasting beyond six months as many management protocols are for acute symptoms. Therefore, PCS management often becomes reactive and a more proactive approach is warranted. Objective: To identify which acute modifiable post-concussive symptoms in adults sustain an elevated risk for developing PCS, therefore requiring early therapeutic intervention. Search Strategy: A predetermined set of search terms was used. Between April 4 to 7 2018 the following databases were searched: CINAHL, MEDLINE, PsycINFO, Scopus, Web of Science, OpenGrey and NICE Evidence. Selection Criteria: All prognostic studies that fulfilled a predetermined selection criteria and evaluated acute adult PCS predictors lasting six months or greater were accepted. Data Collection and Analysis: One reviewer independently extracted data and assessed the methodological quality of all studies using the Quality in Prognosis Studies (QUIPS) tool. Studies were graded as a “low,” “moderate” or “high” risk across six biases, followed by an overall quality rating of “low,” “moderate” or “high.” Main Results: Of the initial 2810 articles identified, 11 articles primarily of low to moderate quality were included. The most common and significant acute predictors to symptom improvement were depression, headaches and post-traumatic stress (PTS). No conclusive predictors were found to predict return to work (RTW) or quality of life (QOL). Conclusions: A definitive conclusion could not be made regarding the most significant acute predictors to prolonged symptom improvement, RTW and QOL in adults with PCS. This was due to the lack of high quality research, varied methodologies, and numerous predictor combinations. However, evidence suggests emotional predictors may be more predictive than physical or cognitive in relation to all outcomes. Further research is required before clinical suggestions can be made.