Clinical Question

Is prescribing rest an appropriate treatment for children who are recovering from a concussion?

Bottom Line

Children who have experienced a concussion should not be placed on bed rest but may return to their previous activity level as allowed by the development of new and worsening symptoms. (Level of Evidence = 1a−)

Synopsis

The researchers conducted a systematic review of four databases and identified 24 English-language studies (including 10 randomized controlled trials) of children with concussion to determine the effect of activity on symptoms, quality of life, and return to preinjury activity levels after a concussion. They followed PRISMA guidelines for conducting and reporting the results. The results from randomized trials were combined for meta-analysis. In seven studies with a total of 269 participants, symptom resolution was slightly better in children who returned to normal activity rather than prescribed rest (standardized mean difference = 0.39; 95% CI, 0.15 to 0.63). Quality of life was not affected by rest vs. return to normal activity, and the rate of return to preinjury activity levels could not be assessed. For study outcomes that could be combined, there was no evidence of heterogeneity among the studies. Risk of bias was high in the randomized controlled studies because of the lack of masking of the children to their treatment assignment. Publication bias was not reported.