Medical Student Vanderbilt University School of Medicine
Introduction: Vestibular rehabilitation is often used to treat athletes after sport-related concussion (SRC). We sought to: 1) identify the relationship between time of vestibular rehabilitation referral and total symptoms, including dizziness, blurred vision, and balance problems, and 2) evaluate the association between time of vestibular rehabilitation referral and recovery, defined as time to return-to-learn (RTL), return-to-play (RTP), and symptom resolution.
Methods: A retrospective, cohort study of adolescents (12-23 years old) who sustained a SRC from 10/2017-11/2021 treated at a regional sports concussion center was conducted. The primary exposure variable was time of vestibular rehabilitation referral. The primary outcomes were the initial post-concussion symptom scale (PCSS) score, dizziness, blurred vision, and balance problems. Secondary outcomes included time to RTL, RTP, and symptom resolution.
Results: A total of 43 concussed athletes were referred for vestibular therapy; 24 (56%) were female, and mean age was 16.8±2.7 years. The mean time from injury to initial clinic visit was 19.3±18.2 days and the mean time from injury to vestibular rehabilitation referral was 26.8±19.8 days. Regarding primary outcomes, no significant relationship was seen between days to vestibular rehabilitation referral and initial PCSS (r=-0.112,p=0.498), balance problems (r=-0.028,p=0.875), blurred vision (r=-0.136,p=0.428), and dizziness (r=0.062,p=0.725). Regarding secondary outcomes, multivariate linear regression controlling for PCSS, age, and prior concussions found that longer days to vestibular rehabilitation referral was significantly associated with longer time to RTP (β=0.477,p=0.020) and symptom resolution (β=0.623,p=0.003), but not RTL (β=0.072,p=0.688).
Conclusion : In a study of athletes with SRC referred for vestibular therapy, earlier vestibular rehabilitation referral was significantly associated with faster time to RTP and symptom resolution but not RTL. Future investigations should focus on identifying common post-concussive signs/symptoms that serve as indications for referral to vestibular rehabilitation.
