Return-to-learn following sport-related concussion: a systematic review
Bibliographic record
Abstract
OBJECTIVE: Return-to-learn (RTL) recommendations and management protocols for athletes after sport-related concussion (SRC) remain heterogeneous. With respect to academics after SRC, the current systematic review evaluated 3 outcome measures in each included study: 1) RTL definition, 2) RTL duration, and 3) factors associated with longer RTL. METHODS: Studies published before December 2022 that addressed RTL after an SRC were identified via a compressive literature search of the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed databases. Studies solely examining nonsport-related concussion/traumatic brain injury studies were excluded. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the Modified Newcastle-Ottawa Scale for risk of bias. For each study included, the design, participants, interventions, outcomes, results, and conclusions were extracted. RESULTS: Of 1838 studies identified, 21 met the inclusion criteria. These studies represented 8475 athletes (aged 5-27 years) who sustained an SRC. A total of 17/21 (81%) provided an RTL definition. Of the studies that defined RTL as any RTL, the median (range) was 5 (2.5-35.3) days, while the median (range) of those that defined RTL as full RTL without accommodations was 17.5 (3-49) days. Female gender (7/9 studies) and initial symptom severity (3/3 studies) were consistently associated with delayed RTL. Single studies identified anxiety, attention-deficit/hyperactivity disorder (ADHD), and integrated performance management as potential factors for delayed RTL. Age (0/5 studies), concussion history (2/6), depression history (0/1), migraine history (0/2), learning disability (0/1), school type (public vs private) (0/2), and early air travel after SRC (0/1) did not appear to have consistent effects on RTL. CONCLUSIONS: Across 21 primary studies, RTL definitions varied greatly, and similarly, a wide range of days to RTL was seen at 3-35 days. Female gender and initial symptom severity were most consistently associated with prolonged RTL. Certain factors such as a history of ADHD/anxiety showed potential effects but require further investigation. Management guidelines should consider these findings while recognizing the need for more comprehensive research to confirm and quantify the impact of various factors on RTL duration.
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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 | 0.010 | 0.054 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
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".