Exercise Tolerance Testing and Progressive Return to Activity Treatment: Modifying the Buffalo Concussion Assessment and Treatment Protocol for Application in a Military Environment
Abstract
Objectives and rationale for the proposed study: In the 12 months of the proposed project, we plan to (1) build a research team capable of performing a clinical trial of the use of early assessment of exercise tolerance after concussion to determine the severity of concussion and to use guided aerobic exercise to help U.S. Service members (SM) recover more rapidly so that they can return to active duty safely. To accomplish this, we will meet with key personnel at Defense Veterans Brain Injury Center (DVBIC) and/or University of North Carolina/Fort Bragg to discuss status of the current the Progressive Return to Activity protocol and identify gaps that need addressing, feasibility challenges, and how primary care for concussion happens in the military. We plan to develop a unique and field-deployable exertion test and will need to explore challenges to developing the test and how to obtain access to the proposed subject population. We will identify the best site(s) for clinical trial activities based on DVBIC expertise. Applicability and impact of the proposed future clinical trial: The planning grant effort and data will help us to design the eventual clinical trial, which will lead to new knowledge informing the systematic assessment and treatment of activity-induced post-concussive symptoms for the purpose of safely expediting return to full function and participation-level activities for active duty SM. The ultimate goal is to deliver to military primary care providers and rehabilitation specialists an evidence-based treatment plan to treat SM with acute concussion as well as those with delayed recovery after military concussion. What types of patients will this study help and how will it help them? It will help active duty SM to recover safely and more rapidly from concussion. It will help military rehabilitation clinicians to diagnose and appropriately treat active duty SM with prolonged recovery from concussion. What are the potential clinical applications and benefits? The results of this study will inform the development of a clinical trial to see if early, individualized sub-threshold aerobic exercise prescribed by military clinicians to concussed active duty SM helps their patients recover faster than the current practice. This form of treatment may also prevent some active duty SM from experiencing delayed recovery from concussion. What is the projected timeline to achieve the expected patient-related outcome? The timeline for the planning grant is 1 year. The projected timeline to achieve the expected patient-related outcome is 3 years after the start of the future clinical trial. What are the likely contributions of the proposed future clinical trial to advancing the field of complex TBI research, patient care, and/or quality of life? Our project will provide critical evidence to support prescribed sub-symptom threshold aerobic exercise for the active treatment of acute concussion in active duty SM. This will lead to a paradigm shift from the current passive approach to treatment. The translational aspect of the project is unique (using a field-deployable systematic test of exercise tolerance early after concussion for diagnosis, prognosis, and treatment) and would have immediate impact to help military clinicians determine recovery based on physiology rather than solely upon subjective symptoms. A physician-prescribed early, controlled active approach to treatment may also substantially reduce the incidence of delayed recovery in active duty SM and thus the need for additional therapies, a potentially very important result. In SM with delayed recovery, exercise-based treatment offers great promise to help restore function and safe return to duty.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910857
Entities
People
- John Leddy
Organizations
- United States Army
- University at Buffalo