CJSM Blog Journal Club — Preinjury & Postinjury Factors Predicting Recovery in Sports-related Concussions

The new year is upon us, and the first issue of the 2021 Clinical Journal of Sports Medicine has published.

There is much to commend in the issue.  It is always difficult to pick one manuscript among many to highlight in the CJSM Blog Journal club (that’s a good ‘problem’ to have).  

This month, our Jr. Associate Editor Jason L Zaremski, MD has decided to evaluate an original research article looking at pre- and post-injury risk factors that affect clinical recovery time in sport-related concussions.

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Jr. Associate Editor Jason L Zaremski MD

Jason L Zaremski, MD

Introduction:  As we finish up a fall sport season that has been like no other and begin 2021 with renewed spirit, the editors of CJSM and the CJSM blog journal club would like to take a moment to thank all of the health care professionals working tirelessly to keep all of our athletes, patients, support staff, and family members safe. We are proud of how the sports medicine community has conducted itself during this pandemic, and we are hopeful that vaccination will allow us to put this pandemic in the rear view mirror in the not-too-distant future.

To kick off 2021 we would like to review a wonderful manuscript from a team headed by Margot Putukian, M.D., past-president of the AMSSM, which analyzes preinjury and post-injury factors that predict sports-related concussion and clinical recovery time.

Purpose/Specific Aims:

1) The authors evaluated a possible relationship between preinjury risk factors (RFs) and resultant occurrence of concussion.

2) They also sought to examine whether preinjury RFs or post-injury assessments predicted clinical recovery in collegiate athletes

  • defined as days until symptom-free (DUSF) and days until full return to play (DUFRTP)

Read more of this post

The AMSSM Position Statement on Conducting the PPE During the SARS-CoV-2 Pandemic

Dr. Alex B. Diamond, co-author of the recent AMSSM guidance statement on administering the PPE during the COVID pandemic

If you’re like us, we are ready to turn the page on 2020!

Literally and figuratively in CJSM’s case.

We’ve decided to push out the January 2021 issue early to get a start on the New Year!  And we’ve got our first podcast of the, ahem, ‘New Year’ to go along with it.

There are many submissions in this edition to highlight, but today I wanted to bring to the attention of the blog readers and podcast listeners one in particular.

CJSM’s partner society, the American Medical Society for Sports Medicine (AMSSM) convened a writing group early in 2020 to give guidance to clinicians in conducting the pre-participation examination (PPE) during the SARS-Cov-2 pandemic.  The result is a manuscript entitled, “Interim Guidance on the Preparticipation Physical Examination for Athletes During the SARS-CoV-2 Pandemic.”

The pandemic has touched all aspects of our field, and the PPE poses some new challenges that clinicians must address while the SARS virus holds sway.

Co-chair of the AMSSM committee and co-author of the AMSSM statement, Alex B. Diamond, D.O., M.P.H. is our guest on the first podcast of the new year.  The other co-chair was Dusty Narducci, M.D. Drs. Diamond and Narducci headed an illustrious team of authors, many whose names will be recognizable to those in the world of sports medicine (special shout out to two of our CJSM editors on the panel: Dr. William Roberts and Dr. Jason Zaremski).

Dr. Diamond is an Associate Professor in the Departments of Orthopaedics and Pediatrics at Vanderbilt University Medical Center, and among many other positions is also the team physician for several Nashville- area high schools, Vanderbilt University (NCAA D1) and the Nashville Predators of the NHL.

In our conversation we do a deep dive on conducting the PPE during the pandemic.  We cover issues such as venue (medical home vs. mass event), the risk of myocarditis in infected individuals, and the potential barriers to sport access created by the PPE.

Go to the statement, which is now freely available in our January 2021 issue. And go to iTunes to check out this episode and subscribe to all of our podcasts, or go to the journal’s main website to access the podcast and other CJSM media.

What are the long-term health-related QOL effects for women participating in college sports

CJSM Associate Editor Jason Zaremski, MD (center) with colleagues at Florida HS football game with that 2020 look

Online Journal Club November 2020

Jason L Zaremski, MD

Title: Stracciolini A, et al. Female Sport Participation Effect on Long-Term Health-Related Quality of Life, CJSM: November 2020 – Volume 30 – Issue 6 – p 526-532 doi: 10.1097/JSM.0000000000000645

Introduction:  As we turn the corner on a unique fall sports season in the United States and around the world, we as a sports medicine community continue to find ourselves facing innumerable COVID-19 related challenges which must be overcome as we promote safe participation in sport. There is a substantial body of research which demonstrates that participation in sport improves confidence, lowers rates of depression, and improves sense of self and self-confidence. During this pandemic, we are more than ever in need of all these sports-related quality of life outcomes.

In this original research from the Micheli Center for Sports Injury Prevention and other centers (including four colleges), the authors do a deep dive into long-term quality of life measures in female athletes.  As the authors highlight, female athletes who participate in sports are less likely to join gangs or use drugs, and are less likely to have unprotected sex or an unintended pregnancy than non-athletes. Nearly fifty years after the passage of Title IX in 1972, in the midst of a global pandemic none of us have ever faced, the November CJSM Journal Club has chosen to highlight this wonderful manuscript on how participation in sport by females in college can potentially impact long term health quality of life measures. Read more of this post

Exercise as a prescription to address post-concussion syndrome: The CJSM Blog Journal Club

Sports like American football are taking place in the midst of COVID19 — concussions are sure to follow

Our September 2020 edition has just published, and this edition is a particularly compelling one, full of original research.  You have to check it out.

As ever our Jr. Associate Editor Jason Zaremski M.D. has just posted his newest submission to the CJSM journal club.

While COVID19 is wreaking havoc with sports schedules around the globe, there are enough high schools and youth sports programs active that concussions will continue to remain a challenge for clinicians to treat.  And post-concussion syndrome is one particularly challenging aspect to this injury.  Dr. Zaremski walks us through original research looking at an ‘exercise prescription’ to treat post-concussion syndrome.

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Jason Zaremski MD

Gauvin-Lepage J, Friedman D, Grilli L, Sufrategui M, De Matteo C, Iverson, GL, Gagnon I. Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion, Clinical Journal of Sport Medicine: September 2020 – Volume 30 – Issue 5 – p 423-432 doi: 10.1097/JSM.0000000000000634

Introduction:  With the change of seasons, many of our readers return to covering pediatric and adolescent sport. In the Northern Hemisphere, summer vacation is over, and academics and school sports are commencing. Fall is the start of the gridiron football season and there is often a surge of concussed youth who need effective, evidence-based management.

This month the CJSM Journal Club has chosen to highlight original research on the effectiveness of exercise-based rehabilitation in 8-17 year youth who have sustained a concussion. In this age group, return to school is even more important than return to sport, and the lingering difficulties in intellectual ability, vestibular system function, memory, and/or attention can be particularly debilitating.  The authors in this new study report that between 20% and 30% of all concussed youth will endorse post-concussive symptoms (PCS) 1 month after injury. Further research into treatments and modalities aimed at reducing the frequency with which children and adolescents experience PCS is paramount.

Purpose: The authors state two aims:

1) To determine the impact of providing participants (aged 8 to 17 years) who are slow to recover after a concussion with an active rehabilitation intervention (ARI) compared to receiving standard care alone, at 2 and 6 weeks after the initiation of the ARI.

2) To investigate functional recovery 6 weeks after initiation of the ARI.

Setting: Tertiary care pediatric trauma center and associated community health care providers. Read more of this post

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