How often is neck and vestibulo-ocular physiotherapy treatment recommended in people with persistent post-concussion symptoms? A retrospective analysis.

Background: Persistent post-concussion symptoms (PPCS) are complex, and typically involve multidisciplinary assessment and management. The neck and vestibulo-ocular systems are recognised as potential contributors to PPCS, yet it is not clear how often treatment for these systems is warranted.

Objectives: To explore how often neck and vestibulo-ocular treatment is received or recommended in people with PPCS.

Design: Retrospective chart review.

Method: De-identified clinical service data for the calendar year of 2017 were extracted from a single concussion service provider in Dunedin, New Zealand. A summary of the individual assessments and treatments received were extracted and used to determine how often cases were considered to require physician or neuropsychological assessment; and how often cases received or were recommended neck and/or vestibulo-ocular physiotherapy treatment.

Results/findings: 147 cases were included in this study. Physician assessment was considered required in 25 cases (17%), and neuropsychological assessment in 90 cases (61%). For physiotherapy, neck treatment was received or recommended in 80 cases (54%), and vestibulo-ocular treatment in 106 cases (72%). Notably, this included 59 cases (40%) where both neck and vestibulo-ocular treatment were received or recommended.

Conclusions: The high proportion of cases receiving or recommended neck and vestibulo-ocular treatment strongly suggests both these systems often contribute to PPCS, often in overlap. While based on retrospective data, these findings highlight the value of routine neck and vestibulo-ocular examination in the assessment and management of PPCS. Further prospective study would be beneficial to explore these proportions in more detail and in other regions.