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

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


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.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Athletic Injuries / diagnosis*
  • Brain Concussion / diagnosis*
  • Child
  • Child, Preschool
  • Humans
  • Rest
  • Return to Sport*
  • Return to Work
  • Schools
  • Students