Persisting symptoms

    • EBR (conditional)157, 163-17229. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      157. Quinn DK, Mayer AR, Master CL, Fann JR. Prolonged postconcussive symptoms. Am J Psychiatry. 2018;175(2):103-11. doi: 10.1176/appi.ajp.2017.17020235.
      158. Halstead ME. Pharmacologic therapies for pediatric
      concussions. Sports Health. 2016;8(1):50-2. doi: 10.1177/1941738115622158.
      159. Wakerley BR. Medication-overuse headache. Pract Neurol. 2019;19(5):399-403. doi: 10.1136/practneurol-2018-002048.
      160. Cheever K, McDevitt J, Phillips J, Kawata K. The role of cervical symptoms in post-concussion management: a systematic review. Sports Med. 2021;51(9):1875-91. doi: 10.1007/s40279-021-01469-y.
      161. Gil C, Decq P. How similar are whiplash and mild traumatic brain injury? A systematic review. Neurochirurgie. 2021;67(3):238-43. doi:
      10.1016/j.neuchi.2021.01.016.
      162. Rebbeck T, Evans K, Elliott JM. Concussion in combination with whiplash-associated disorder may be missed in primary care: key recommendations for assessment and management. J Orthop Sports Phys Ther. 2019;49(11):819-28. doi: 10.2519/jospt.2019.8946.
      163. Buttner F, Howell DR, Doherty C, Blake C, Ryan J, Delahunt E. Headache- and dizziness-specific health-related quality-of-life impairments persist for 1 in 4 amateur athletes who are cleared to return to sporting activity following sport-related concussion: a prospective matched-cohort study. J Orthop Sports Phys Ther. 2020;50(12):692-701. doi: 10.2519/jospt.2020.9485.
      164. Hromas GA, Houck ZM, Asken BM, Svingos AM, Greif SM, Heaton SC, et al. Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2021;36(3):186-95. doi: 10.1097/HTR.0000000000000618.
      165. Ngwenya LB, Gardner RC, Yue JK, Burke JF, Ferguson AR, Huang MC, et al. Concordance of common data elements for assessment of subjective cognitive complaints after mild-traumatic brain injury: a TRACK-TBI Pilot Study. Brain Inj. 2018;32(9):1071-8. doi: 10.1080/02699052.2018.1481527.
      166. Teymoori A, Gorbunova A, Haghish FE, Real R, Zeldovich M, Wu YJ, et al. Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury. J Clin Med. 2020;9(3). doi: 10.3390/jcm9030873.
      167. Donders J, Pendery A. Clinical Utility of the Patient Health Questionnaire-9 in the Assessment of Major Depression After Broad-Spectrum Traumatic Brain Injury. Arch Phys Med Rehabil. 2017;98(12):2514-9. doi: 10.1016/j.apmr.2017.05.019.
      168. Langer LK, Comper P, Ruttan L, Saverino C, Alavinia SM, Inness EL, et al. Can Sport Concussion Assessment Tool (SCAT) symptom scores be converted to Rivermead Post-concussion Symptoms Questionnaire (RPQ) scores and vice versa? Findings from the Toronto Concussion Study. Front Sports Act Living. 2021;3:737402. doi: 10.3389/fspor.2021.737402.
      169. Medvedev ON, Theadom A, Barker-Collo S, Feigin V, Group BR. Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ). PeerJ. 2018;6:e5676. doi: 10.7717/peerj.5676.
      170. Snell DL, Iverson GL, Panenka WJ, Silverberg ND. Preliminary validation of the World Health Organization Disability Assessment Schedule 2.0 for mild traumatic brain injury. J Neurotrauma. 2017;34(23):3256-61. doi: 10.1089/neu.2017.5234.
      171. Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, et al. Exploring vestibular ocular motor screening in adults with persistent complaints after mild traumatic brain injury. J Head Trauma Rehabil. 2022;37(5):E346-E54. doi: 10.1097/HTR.0000000000000762.
      172. Shaikh N, Theadom A, Siegert R, Hardaker N, King D, Hume P. Rasch analysis of the Brain Injury Screening Tool (BIST) in mild traumatic brain injury. BMC Neurol. 2021;21(1):376. doi: 10.1186/s12883-021-02410-6.
      Adapted29
    • EBR (conditional)30. Zemek R, Reed N, Dawson J, Ledoux AA. Living guideline for pediatric concussion care 2023 [Available from: www.pedsconcussion.com; https://doi.org/10.17605/OSF.IO/3VWN9.Adapted30
    • CBR29. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.Adapted29
    • CBR30. Zemek R, Reed N, Dawson J, Ledoux AA. Living guideline for pediatric concussion care 2023 [Available from: www.pedsconcussion.com; https://doi.org/10.17605/OSF.IO/3VWN9.Adapted30
    • EBR (strong)160,17329. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      160. Cheever K, McDevitt J, Phillips J, Kawata K. The role of cervical symptoms in post-concussion management: a systematic review. Sports Med. 2021;51(9):1875-91. doi: 10.1007/s40279-021-01469-y.
      173. Anderson JFI. The association between pain type, cognition and complaint after mild traumatic brain injury in prospectively studied premorbidly healthy adults admitted to hospital. Neuropsychology. 2020;34(1):53-62. doi: 10.1037/neu0000585.
      Adapted29
    • EBR (strong)160,173160. Cheever K, McDevitt J, Phillips J, Kawata K. The role of cervical symptoms in post-concussion management: a systematic review. Sports Med. 2021;51(9):1875-91. doi: 10.1007/s40279-021-01469-y.
      173. Anderson JFI. The association between pain type, cognition and complaint after mild traumatic brain injury in prospectively studied premorbidly healthy adults admitted to hospital. Neuropsychology. 2020;34(1):53-62. doi: 10.1037/neu0000585.
      New
  • Differential diagnoses related to mTBI/concussion:
    Major depressive disorderGeneralised anxiety disorderPost-traumatic stress disorderChronic pain syndromeCervical strain/whiplash associated disorderSomatic syndrome disorderFunctional neurological disorderMalingeringFibromyalgia syndrome (secondary)Primary sleep disorder (e.g. obstructive sleep apnoea)
    Source: Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023.
    • EBR (strong)160,163-1677. McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-47. doi: 10.1136/bjsports-2017-097699.
      29. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      160. Cheever K, McDevitt J, Phillips J, Kawata K. The role of cervical symptoms in post-concussion management: a systematic review. Sports Med. 2021;51(9):1875-91. doi: 10.1007/s40279-021-01469-y.
      163. Buttner F, Howell DR, Doherty C, Blake C, Ryan J, Delahunt E. Headache- and dizziness-specific health-related quality-of-life impairments persist for 1 in 4 amateur athletes who are cleared to return to sporting activity following sport-related concussion: a prospective matched-cohort study. J Orthop Sports Phys Ther. 2020;50(12):692-701. doi: 10.2519/jospt.2020.9485.
      164. Hromas GA, Houck ZM, Asken BM, Svingos AM, Greif SM, Heaton SC, et al. Making a Difference: Affective Distress Explains Discrepancy Between Objective and Subjective Cognitive Functioning After Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2021;36(3):186-95. doi: 10.1097/HTR.0000000000000618.
      165. Ngwenya LB, Gardner RC, Yue JK, Burke JF, Ferguson AR, Huang MC, et al. Concordance of common data elements for assessment of subjective cognitive complaints after mild-traumatic brain injury: a TRACK-TBI Pilot Study. Brain Inj. 2018;32(9):1071-8. doi: 10.1080/02699052.2018.1481527.
      166. Teymoori A, Gorbunova A, Haghish FE, Real R, Zeldovich M, Wu YJ, et al. Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury. J Clin Med. 2020;9(3). doi: 10.3390/jcm9030873.
      167. Donders J, Pendery A. Clinical Utility of the Patient Health Questionnaire-9 in the Assessment of Major Depression After Broad-Spectrum Traumatic Brain Injury. Arch Phys Med Rehabil. 2017;98(12):2514-9. doi: 10.1016/j.apmr.2017.05.019.
      174. Hsu HH, Lai WH, Yu HT, Xiao SH, Tsai YH, Wang KC, et al. Long-term presentation of postconcussion symptoms and associated factors: analysis of latent class modeling. Arch Clin Neuropsychol. 2021;36(1):62-73. doi: 10.1093/arclin/acaa063.
      Adapted29
    • EBR (conditional)180-18829. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      30. Zemek R, Reed N, Dawson J, Ledoux AA. Living guideline for pediatric concussion care 2023 [Available from: www.pedsconcussion.com; https://doi.org/10.17605/OSF.IO/3VWN9.
      180. Beaton MD, Hadly G, Babul S. Stakeholder recommendations to increase the accessibility of online health information for adults experiencing concussion symptoms. Front Public Health. 2020;8:557814. doi: 10.3389/fpubh.2020.557814.
      181. Belanger HG, Toyinbo P, Barrett B, King E, Sayer NA. Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans. Clin Neuropsychol. 2022;36(8):2093-119. doi: 10.1080/13854046.2021.1936188.
      182. Caplain S, Chenuc G, Blancho S, Marque S, Aghakhani N. Efficacy of Psychoeducation and Cognitive Rehabilitation After Mild Traumatic Brain Injury for Preventing Post-concussional Syndrome in Individuals With High Risk of Poor Prognosis: A Randomized Clinical Trial. Front Neurol. 2019;10:929. doi: 10.3389/fneur.2019.00929.
      183. Donnelly KZ, Goldberg S, Fournier D. A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers. Disabil Rehabil. 2020;42(17):2482-91. doi: 10.1080/09638288.2018.1563638.
      184. Losoi H, Silverberg ND, Waljas M, Turunen S, Rosti-Otajarvi E, Helminen M, et al. Recovery from Mild Traumatic Brain Injury in Previously Healthy Adults. J Neurotrauma. 2016;33(8):766-76. doi: 10.1089/neu.2015.4070.
      185. O’Neil ME, Carlson K, Storzbach D, Brenner L, Freeman M, Quinones A, et al.  Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. VA Evidence-based Synthesis Program Reports. Washington (DC)2013.
      186. Rakers SE, Timmerman ME, Scheenen ME, de Koning ME, van der Horn HJ, van der Naalt J, et al. Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study. Arch Phys Med Rehabil. 2021;102(10):1965-71 e2. doi: 10.1016/j.apmr.2021.06.004.
      187. Rytter HM, Graff HJ, Henriksen HK, Aaen N, Hartvigsen J, Hoegh M, et al. Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA Netw Open. 2021;4(11):e2132221. doi: 10.1001/jamanetworkopen.2021.32221.
      188. McMahon P, Hricik A, Yue JK, Puccio AM, Inoue T, Lingsma HF, et al. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26-33. doi: 10.1089/neu.2013.2984.
      Adapted29,30
    • EBR (conditional)136-13829. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      136. Maerlender A, Rieman W, Lichtenstein J, Condiracci C. Programmed physical exertion in recovery from sports-related concussion: a randomized pilot study. Dev Neuropsychol. 2015;40(5):273-8. doi: 10.1080/87565641.2015.1067706.
      137. Remigio-Baker RA, Bailie JM, Gregory E, Cole WR, McCulloch KL, Cecchini A, et al. Activity level during acute concussion may predict symptom recovery within an active duty military population. J Head Trauma Rehabil. 2020;35(2):92-103. doi: 10.1097/HTR.0000000000000498.
      138. Brett BL, Breedlove K, McAllister TW, Broglio SP, McCrea MA, Investigators CC, et al. Investigating the range of symptom endorsement at initiation of a graduated return-to-play protocol after concussion and duration of the protocol: A study from the National Collegiate Athletic Association-Department of Defense Concussion, Assessment, Research, and Education (CARE) Consortium. Am J Sports Med. 2020;48(6):1476-84. doi: 10.1177/0363546520913252.
      Adapted29
    • EBR (strong)189-19729. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.
      Cifu DX, Hart BB, West SL, Walker W, Carne W. The effect of hyperbaric oxygen on persistent postconcussion symptoms. J Head Trauma Rehabil. 2014;29(1):11-20. doi: 10.1097/HTR.0b013e3182a6aaf0.
      190. Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, et al. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Ann Neurol. 2014;75(2):277-86. doi: 10.1002/ana.24067.
      191. Walker WC, Franke LM, Cifu DX, Hart BB. Randomized, sham-controlled, feasibility trial of hyperbaric oxygen for service members with postconcussion syndrome: cognitive and psychomotor outcomes 1 week postintervention. Neurorehabil Neural Repair. 2014;28(5):420-32. doi: 10.1177/1545968313516869.
      192. Dong Y, Hu X, Wu T, Wang T. Effect of hyperbaric oxygenation therapy on post-concussion syndrome. Exp Ther Med. 2018;16(3):2193-202. doi: 10.3892/etm.2018.6463.
      193. Hart BB, Weaver LK, Gupta A, Wilson SH, Vijayarangan A, Deru K, et al. Hyperbaric oxygen for mTBI-associated PCS and PTSD: Pooled analysis of results from Department of Defense and other published studies. Undersea Hyperb Med. 2019;46(3):353-83. doi:
      194. Meehan A, Hebert D, Deru K, Weaver LK. Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. J Vestib Res. 2019;29(4):205-19. doi: 10.3233/VES-180671.
      195. Walker JM, Mulatya C, Hebert D, Wilson SH, Lindblad AS, Weaver LK. Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls. Sleep Med. 2018;51:66-79. doi: 10.1016/j.sleep.2018.06.006.
      196. Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K, Price RC, et al. Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial. Undersea Hyperb Med. 2018;45(2):129-56. doi:
      197. Harch PG, Andrews SR, Rowe CJ, Lischka JR, Townsend MH, Yu Q, et al. Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial. Med Gas Res. 2020;10(1):8-20. doi: 10.4103/2045-9912.279978.
      Adapted29
    • CBR30. Zemek R, Reed N, Dawson J, Ledoux AA. Living guideline for pediatric concussion care 2023 [Available from: www.pedsconcussion.com; https://doi.org/10.17605/OSF.IO/3VWN9.Adapted30
    • CBR12830. Zemek R, Reed N, Dawson J, Ledoux AA. Living guideline for pediatric concussion care 2023 [Available from: www.pedsconcussion.com; https://doi.org/10.17605/OSF.IO/3VWN9.
      128. Leddy JJ, Burma JS, Toomey CM, Hayden A, Davis GA, Babl FE, et al. Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. Brit J Sports Med. 2023;57(12):762-70. doi: 10.1136/bjsports-2022-106676.
      Adapted30
    • CBR29. Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: Guideline for concussion and prolonged symptoms for adults 18 years or older 2023 [Available from: https://concussionsontario.org.Adapted29