5.8 Effectiveness of early multi-dimensional rehabilitation following sport-related concussion: a randomized trial
Bibliographic record
Abstract
Objective Evaluate effectiveness of early-stage multi-dimensional rehabilitation (MDR) on return to sport (RTS). Design Two-arm randomized unblinded trial (NCT02988596). Setting Professional, collegiate, and interscholastic sports (28 sites in USA, Canada, and New Zealand). Participants Consented participants with provider-diagnosed concussion (n=251; 52 professional-Canadian football, 31 professional rugby, 128 college/university, 40 interscholastic; 20% female), randomized by site. Interventions (or Assessment of Risk Factors) An early-MDR arm (n=132) included cognitive, visual-vestibular, symptom comfort, and balance activities; after the athlete was asymptomatic, MDR activities were integrated with standardized sport-specific Enhanced Graded Exertion (EGE) strategies. The comparator EGE arm (n=119) used only conventional exertion strategies (i.e. no early-stage MDR). Prescribed MDR-arm activities started after symptoms stabilized (i.e. pre-asymptomatic). Prescribed EGE activities started once deemed clinically asymptomatic (within 85% of pre-injury baseline). Both arm-specific protocols were initiated at first visit post-injury and continued to RTS clearance. Outcome Measures Multistage survival models analyzed complete days from injury until asymptomatic, and complete days post-asymptomatic to full medical clearance for RTS. Main Results Time to asymptomatic did not differ between arms (p=0.8612). Thereafter (i.e. post-asymptomatic), MDR athletes more rapidly progressed to RTS clearance (p<0.0001). MDR athletes (median 13 days; 95%CI: 13, 16) therefore achieved RTS clearance following concussion quicker (p=0.0190) than EGE-only athletes (median 19 days; 95%CI: 15, 22). By 14 days post-injury, 54.6% of MDR-arm athletes were cleared for RTS, compared to versus 37.8% of EGE-only athletes (p=0.0019). Conclusions Notwithstanding similar initial symptom recovery times, MDR athletes progressed through the post-asymptomatic RTS strategy significantly faster than EGE athletes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.016 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".