1 Department of Health, Kinesiology, & Applied Physiology, Concordia University, Montreal, QC, Canada.
2 Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.
3 Montreal Children's Hospital, McGill University Health Centre (Trauma Centre), Montreal, QC, Canada.
4 Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
5 Canadian Hospitals Injury Reporting & Prevention Program, Health Canada, Ottawa, ON, Canada.

Context: In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes.

Design: Secondary analysis of prospectively collected clinical data.

Methods: 600 youth with concussion were included. Active rehabilitation was initiated =4 weeks (prepolicy) or =2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted.

Results: The postpolicy group (median = 22 d [interquartile range: 17-27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24-30], P < .001). Length of episode of care (?2(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19-1.88); rehabilitation (?2(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22-2.45]); and total recovery (?2(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18-1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F2,320 = 3.59, P = .03) and symptom change scores (F2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms.

Conclusions: Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.