Prognostic Value of Vestibular Symptoms on the Vestibular Ocular Motor Screening for Return-to-play After Sport-related Concussion: A Systematic Review and Meta-analysis

Background and Purpose: The vestibulo-ocular reflex (VOR) contributes to gaze stabilization after head movement, but its independent prognostic value for return-to-play (RTP) after sport-related concussion (SRC) is unclear. This systematic review and meta-analysis examined associations between early vestibular-ocular motor screening (VOMS) assessment and RTP duration following SRC. Methods: Searches of PubMed, CINAHL, Scopus, PEDro, and Cochrane Library to March 2025 identified studies assessing within 14 days of SRC and reporting RTP outcomes. Two reviewers extracted data and assessed the risk of bias. Random-effects meta-analysis was performed for studies reporting prolonged recovery (≥28–30 days). Results: Twelve studies (N = 3297 athletes) met inclusion criteria. Meta-analysis of four studies (n = 968) found a positive VOMS screen was associated with increased odds of prolonged recovery (odds ratio 2.39; 95% confidence interval, 1.82–3.13; P < 0.00001; I2=0%). Among nine studies of isolated VOR gain, eight reported significant univariate associations with longer RTP, but only two retained significance after multivariable adjustment. VOMS reliably identifies athletes at risk for protracted recovery, but isolated VOR measures show inconsistent independent predictive value after adjustment. Discussion and Conclusions: Objective VOR gain quantification (eg, vHIT, caloric) is needed to clarify whether physiological VOR dysfunction independently affects recovery. Clinicians should interpret VOR findings within a multimodal assessment.