Activity and Recovery Among Youth With Concussion: A Meta-analysis

Pediatrics. 2023 May 1;151(5):e2022059592. doi: 10.1542/peds.2022-059592.


Context: Concussions in youth are highly prevalent. Previously, rest was prescribed to prevent adverse outcomes; however, early return to activity is emerging to improve the recovery trajectory.

Objectives: To evaluate the effectiveness of early return to physical and social activity interventions on recovery outcomes in youth with concussion.

Data sources: A systematic review was conducted up to October 2022.

Study selection: We included randomized controlled trials (RCTs) and non-RCTs that reported effects of activity-based interventions on symptoms, quality-of-life (QoL), and return to preinjury activity levels in children and youth after a concussion.

Data extraction: Three authors independently extracted data on publication year and country, study setting and design, sample size, participant demographics, intervention, outcome(s), and author conclusion. Meta-analysis was conducted on appropriate RCTs.

Results: Twenty-four studies were included in the final review, of which 10 were RCTs. There was a significant effect of activity interventions on symptom reporting (standardized mean difference, 0.39 [95% confidence interval, 0.15 to 0.63]; I2, 0%; P = .002). There was not a significant effect of activity-based interventions on QoL (mean difference, -0.91 [95% confidence interval, -7.76 to 5.94]; I2, 0%; P = .79). No meta-analysis was performed on return to preinjury activity levels because of insufficient number of RCTs conducted.

Limitations: One outcome was excluded from the meta-analysis. Interventions emphasizing social activity were lacking.

Conclusions: Findings indicate that activity-based interventions may significantly improve concussion symptoms. There is insufficient data to understand the effect of activity-based intervention on QoL and return to preinjury activity levels.

Publication types

  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Brain Concussion* / therapy
  • Child
  • Humans