@article{ref1,
title="Effectiveness of non-pharmacological therapy on physical symptoms in patients with persistent concussion symptoms: a systematic review",
journal="Journal of neurotrauma",
year="2023",
author="Moser, Nicholas and Gagoum, Shawn and Popovic, Milos R. and Kalsi-Ryan, Sukhvinder",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: To examine the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. DATA SOURCE: PubMed, MEDLINE, Cochrane library, CINAHL and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical postconcussion symptoms. STUDY SELECTION AND EXTRACTION: Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. Grading of Recommendations Assessment, Development, and Evaluation system was applied to rate the quality of evidence. 32 articles were included. DATA SYNTHESIS: Preliminary evidence suggests Transcranial Magnetic Stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following sub-symptom aerobic training as well as cervical spine manual therapy. Tentatively, adults demonstrated changes in symptoms following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches. Multimodal therapy in adults showed significant change in physical symptoms when compared to usual care. However, no further reduction in physical symptoms were observed when adult patients received a program of care that afforded cervicovestibular rehabilitation with symptom limited exercise compared to symptom limited exercise program alone. Cognitive behavioural therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches. Veterans had a significant change in postconcussive symptoms following 3-month use of an interactive smartphone application as compared to standard care. Finally, in a pediatric population the use of melatonin did not demonstrate any changes in physical persistent concussion symptoms as compared to placebo. <br><br>CONCLUSION: Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, interpretation of the results needs to be taken with caution.<p /> <p>Language: en</p>",
language="en",
issn="0897-7151",
doi="10.1089/neu.2023.0474",
url="http://dx.doi.org/10.1089/neu.2023.0474"
}