Article Impact Level: HIGH Data Quality: STRONG Summary of British Journal of Sports Medicine, https://doi.org/10.1136/bjsports-2025-109807 Dr. Tara L Alvarez et al.
Points
- The CONCUSS trial compared immediate versus delayed OBVAM therapy for concussion-related convergence insufficiency in 11–25 year olds.
- At 6 weeks, 88% of the immediate group showed success/improvement, versus 8% of the delayed group (p<0.001).
- Immediate therapy significantly improved NPC by 7.9 cm and PFV by 17.5Δ, with p<0.001 for both.
- Symptom improvement occurred in 79% of the immediate group versus 13% of the delayed group (p<0.001).
- Immediate OBVAM effectively shortens symptom duration and fosters an earlier return to activities for CONC-CI patients.
Summary
The CONCUSS randomized clinical trial investigated the effectiveness of immediate versus delayed office-based vergence/accommodative therapy with movement (OBVAM) for treating concussion-related convergence insufficiency (CONC-CI). The study enrolled 104 participants aged 11–25 years experiencing persisting postconcussive symptoms 4–24 weeks post-injury, diagnosed with symptomatic CONC-CI via clinical signs (near point of convergence [NPC], positive fusional vergence [PFV]) and symptoms (Convergence Insufficiency Symptom Survey [CISS]). Participants were randomized to either an immediate OBVAM group (twice weekly for 6 weeks, totaling 12 sessions) or a delayed OBVAM group.
At the outcome time 1 assessment (after 6 weeks), the immediate group demonstrated significantly superior outcomes. Based on a composite primary outcome of NPC and PFV, 46/52 (88%) in the immediate group were classified as successful or improved, compared to only 4/52 (8%) in the delayed group (p<0.001). Specifically, the mean NPC improved by 7.9 cm in the immediate group versus 1.8 cm in the delayed group (mean difference: 5.1 cm; 95% CI: 3.9 to 6.3; p<0.001). Similarly, mean PFV increased by 17.5Δ in the immediate group versus 2.5Δ in the delayed group (mean difference: 15.0Δ; 95% CI: 11.7 to 18.3; p<0.001). Symptomatic improvement, as per CISS scores, was seen in 41/52 (79%) of the immediate group compared to 7/52 (13%) of the delayed group (p<0.001).
Further analysis in the immediate group showed that 12 OBVAM sessions yielded 88% success/improvement, increasing to 94% after 16 sessions. At the outcome time 2 assessment, after both groups received all 16 OBVAM sessions, no significant difference was observed between them for NPC, PFV, or CISS (p=1.0). This indicates that while both immediate and delayed therapy ultimately achieved similar results with full dosing, immediate initiation of OBVAM significantly shortens the duration of symptoms and facilitates an earlier return to activities, underscoring its clinical importance in concussion management.
Link to the article: https://bjsm.bmj.com/content/early/2025/09/30/bjsports-2025-109807
References
Alvarez, T. L., Scheiman, M., Hajebrahimi, F., Noble, M., Gohel, S., Baro, R., Bachman, J. A., Master, C. L., & Goodman, A. (2025). CONCUSS randomised clinical trial of vergence/accommodative therapy for concussion-related symptomatic convergence insufficiency. British Journal of Sports Medicine, bjsports-2025-109807. https://doi.org/10.1136/bjsports-2025-109807
