A randomised clinical trial published in the British Journal of Sports Medicine on 26 May 2026 shows that early, symptom-targeted, multidisciplinary treatment more than doubles the odds of full recovery in children with persisting post-concussion symptoms – findings that carry significant implications for how paediatric concussion care is structured and delivered in clinics worldwide.
Concussion is one of the most common reasons children present to hospital following a head injury, yet for around 30% of them, symptoms do not resolve within the expected two-to-four-week window. These children are left navigating a fragmented healthcare system, bouncing between GPs, physiotherapists, and specialists – sometimes waiting weeks between each referral – while their symptoms quietly entrench. A new Australian trial suggests there is a better way, and the lessons it offers are directly applicable to clinical practice far beyond the country’s borders.
The Concussion Essentials (CE) trial, led by researchers at the Murdoch Children’s Research Institute (MCRI) in Melbourne, evaluated a structured, multidisciplinary intervention for children aged 8 to 18 who were still symptomatic two to three weeks after a concussion. The results were striking. At three months post-injury, 62.5% of children who received the CE intervention had fully recovered, compared with 37% of those receiving standard care – a risk difference of 25.5 percentage points. Secondary outcomes told an equally compelling story: post-treatment symptom severity scores were dramatically lower in the intervention group across all domains, including physical, cognitive, emotional, and sleep and fatigue measures.
Why this matters beyond Australia
The trial was conducted at a single tertiary paediatric hospital in Melbourne, but its implications extend well beyond that setting. Persisting post-concussion symptoms (PPCS) are a global challenge, and the fragmented, unimodal approaches that currently characterise care in many health systems – where a child might see a physiotherapist for headaches one week and wait months for psychological support – are precisely the model the CE intervention was designed to replace.
As the authors conclude in the paper: “Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion.” For clinicians in the Middle East and beyond, that conclusion is a direct challenge to current practice.
MCRI researcher Vanessa Rausa puts it plainly. “While most children recover well after concussion, almost a third continue to experience symptoms that disrupt school, sport and everyday life,” she said. “This study shows that if we identify those children early and provide targeted, coordinated care, we can significantly speed up recovery.”
The intervention: one stop, eight weeks
The CE programme was delivered over up to eight weekly one-hour sessions, beginning four weeks post-injury. It was built around three treatment domains: education (psychoeducation, and management of headache, fatigue, sleep, and return to school and sport), physiotherapy (vestibular, oculomotor, graded exertion, and cervical symptom management), and psychology (a manualised cognitive-behavioural therapy programme focusing on thoughts, feelings, behaviour, stress, and coping).
Crucially, the intervention was not a fixed protocol. Module selection was driven by weekly clinician consensus, previous session content, and the most burdensome presenting symptoms. Children progressed through or between modules depending on how their symptom profile evolved. Concussion education and physiotherapy were prioritised in the first two weeks; psychological support ramped up from weeks four to five, then all modules tapered as children improved. In all, participants received up to 16 modules across the eight sessions.
The 158 participants – 78 in the CE arm, 80 receiving usual care – were recruited between August 2019 and July 2024 from the Royal Children’s Hospital emergency department and through community referrals. Their mean age was 13 years; the majority (57.6%) were male. All had been symptomatic at a 14day post-injury screening and confirmed symptomatic at baseline assessment three weeks after injury.
Primary outcome was full recovery at trial completion, defined conservatively as endorsement of no more than one post-concussive symptom of increased severity compared with pre-injury status on the Post-Concussion Symptom Inventory, parent version (PCSI-P). The authors were candid about the deliberate rigour of this threshold: using alternative definitions, such as fewer than three symptoms, might have yielded even higher functional recovery rates.
The child’s experience: Macy’s story
For families, the difference between standard care and the CE clinic was more than statistical. Macy, 15, sustained a concussion during a school surfing excursion after striking her head on the ocean floor. Though she seemed fine initially, by the following day it was clear something was wrong.
Her mother Jo described the aftermath: “Macy was not herself at all. She was absent minded, emotional, tired and easily overwhelmed, had headaches and kept bumping into things.” Three days after the injury, Macy tried to return to school but was overwhelmed by classroom noise and left in tears.
After seeing a GP and being referred to both a sports doctor and a physiotherapist, the family heard about the MCRI concussion clinic. The experience, Jo said, was transformative. “We didn’t have to convince the clinic staff of anything, they understood concussion immediately. Macy finally had the practical support she needed, and the team liaised with her school, recommending tailored adjustments.” Macy’s recovery took around five months – longer than hoped – but Jo noted: “The girl who walked into the clinic and the one who walked out were completely different.”
Sex differences and subgroup findings
One notable signal in the data was a differential treatment response by sex. Males and children aged 11 to 12 years appeared to show the greatest benefit from the CE intervention, while recovery rates were lower in females. The study was not powered to formally test sex differences, but the pattern echoes findings from previous literature suggesting that females tend to report greater symptom frequency and severity and are more likely to develop PPCS. As the authors note in the discussion, “there is minimal research examining sex-specific responses to concussion treatment for children and adolescents who experience PPCS,” and this remains an important area for future investigation.
Sample retention was high despite the considerable commitment required – 69 of 78 CE participants and 75 of 80 usual care participants completed the trial – which the authors interpret as evidence that the programme was both feasible and acceptable to families.
Limitations and the road ahead
The trial was conducted at a single, well-resourced tertiary centre, and the authors are measured about what remains to be done. Strict exclusion criteria – including pre-existing neurological or significant psychiatric conditions – mean that the findings may not immediately generalise to more clinically complex patients. The resource intensity of weekly, face-to-face, multidisciplinary sessions may also present barriers in lower-resource settings or for families in rural and remote areas.
Professor Vicki Anderson, MCRI Theme Director for Clinical Sciences, acknowledged these constraints but argued the findings nonetheless set a clear direction. “Concussion is a growing health concern, with diagnosis and management poorly understood,” she said. “Children don’t experience concussion in a single way. By bringing education, physiotherapy and psychological care together and tailoring treatment to each child, we can respond to those different needs.”
Future work, she said, would focus on whether the model could be delivered through telehealth and scaled to community clinic settings – developments that could substantially extend access for families outside metropolitan centres.
The free Concussion Essentials (Head-Check) app, developed by MCRI in collaboration with the Australian Football League, is one practical step in that direction, offering parents, coaches, and players an accessible tool to identify when medical attention may be needed and to support safe recovery management.
Journal reference:
Anderson, V., Davies, K., Rausa, V. C., et al. (2026). Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial. British Journal of Sports Medicine, 60, 856–864.
https://doi.org/10.1136/bjsports-2025-110880
