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UBC Theses and Dissertations

Activity engagement after concussion in youth Chauhan, Rochelle


Background. Concussions are highly prevalent injuries, particularly among youth populations. Symptoms of concussion are broad and varied among individuals, across physical, cognitive, emotional, and sleep-related domains. Most people experience full recovery from concussions; however, approximately 30% of individuals continue to experience symptoms beyond the normal recovery period. Guidelines to manage concussion recovery indicate a gradual return to activity. However, there is limited evidence on how engagement in activity influences recovery and how to effectively promote activity re-engagement in youth with concussion. This thesis will build evidence to support the integration of activity following a concussive event in youth. Aims. 1) To examine the influence of physical and social activity on recovery in children and youth with concussions. 2) To develop an intervention that will enable an early return to activity after a concussion in an effort to improve the recovery trajectory in youth. Methods. Two study designs were utilized to address our aims: 1) A systematic review and meta-analysis was conducted to assess the influence of social and/or physical activity on concussion recovery in adolescents. All types of intervention studies investigating social and physical activity to improve concussion recovery in youth were identified. 2) An intervention mapping framework was used to design an intervention to improve activity engagement after concussion in youth, encompassing current return to activity guidelines and using a personalized rehabilitation approach. Results. Overall, engagement in activity positively influenced recovery concussion outcomes in youth, with results used to guide the development of a novel intervention. In the systematic review, 19 studies were included, of which 8 were RCTs. There was a significant effect of activity interventions on decreased symptom reporting (SMD = 0.39 [95% CI = 0.14 to 0.64], I2 = 0%, p = 0.002), but no significant effect on quality of life. The Concussion Coach intervention was developed to improve recovery outcomes after concussion in youth through a guideline-based, individualised, goal-oriented telerehabilitation approach. Conclusion. Findings from this thesis extend knowledge of concussion recovery in youth. This thesis indicated that activity-based interventions, individualized rehabilitation, and health delivery innovations may be important components for youth concussion interventions.

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