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      Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data

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          Abstract

          Objectives

          To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment .

          Design

          Systematic review and meta-analysis using individual participant data (IPD).

          Data sources

          The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017.

          Eligibility criteria for study selection

          Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case–control matching.

          Data extraction and synthesis

          Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a ‘one-stage’, random-effects model.

          Results

          26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ 2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ 2=10.3; df=4; p=0.036; mean difference −0.0039 m; 95% CI: −0.0075 to −0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion.

          Summary/conclusions

          Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7–10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion.

          Protocol pre-registration

          This systematic review was prospectively registered in PROSPERO CRD42017064861.

          Related collections

          Most cited references33

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          Attention and the control of posture and gait: a review of an emerging area of research.

          Research on the relationship between attention and the control of posture and gait is a new and expanding area with studies on young adults revealing the role of cognitive factors in the control of balance during standing and walking. The use of dual task paradigms to examine the effect of age related changes in attentional requirements of balance control and age-related reductions in stability when performing a secondary task has shown that these are important contributors to instability in both healthy and balance-impaired older adults. The attentional demands of balance control vary depending on the complexity of the task and the type of secondary task being performed. New clinical assessment methods incorporating dual-task paradigms are helpful in revealing the effect of disease (e.g. Parkinson's disease) on the ability to allocate attention to postural tasks and appear to be sensitive measures in both predicting fall risk and in documenting recovery of stability. Copyright 2002 Elsevier Science B.V.
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            Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature

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              “Playing Through It”: Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery

              Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.
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                Author and article information

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                Journal
                British Journal of Sports Medicine
                Br J Sports Med
                BMJ
                0306-3674
                1473-0480
                January 03 2020
                January 2020
                January 2020
                July 22 2019
                : 54
                : 2
                : 94-101
                Article
                10.1136/bjsports-2018-100164
                31331944
                a84812c5-6f7d-42ef-8e3f-c74a95560cb9
                © 2019
                History

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