Trial Outcomes & Findings for Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes in mTBI? (NCT NCT03479541)

NCT ID: NCT03479541

Last Updated: 2025-06-24

Results Overview

Self-rated questionnaire for dizziness impairment rated on a 3-point scale (0: no; 2: sometimes; 4: always) with a maximum score of 100. Higher scores indicate worse outcome.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 203 participants
• Primary outcome timeframe: Earlier Physical Therapy (PT) Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)
• Results posted on: 2025-06-24

Participant Flow

Participants were screened for eligibility (n=2522) and recruited from institutional and local clinics in the Portland Metropolitan area. Recruitment and enrollment started in July 2018 and ended in March of 2023.

In-person physical therapy (PT) stopped March 2020 due to COVID-19. From April 2020 to September 2020, 18 participants were enrolled in the study and received telerehabilitation. However, these participants were not included in further analyses due to differences from the in-person PT sessions. Although there are 4 arms to the study, those included in the early and late PT groups were the same people in the home monitoring groups. Therefore, the total included is 203 (not 406).

Participant milestones

Measure	Earlier Physical Therapy Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Later Physical Therapy (Standard of Care) Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Physical Therapy With Home Monitoring Wearable sensors were worn during home exercises and biofeedback was reviewed in the next physical therapy appointment.	Physical Therapy (Without Home Monitoring) Home exercise was completed without wearable sensors, and biofeedback was not given on home exercise performance.
Early and Late Physical Therapy STARTED	82	121	0	0
Early and Late Physical Therapy Started Physical Therapy	75	81	0	0
Early and Late Physical Therapy Completed Post-Physical Therapy Assessments	63	63	0	0
Early and Late Physical Therapy COMPLETED	63	63	0	0
Early and Late Physical Therapy NOT COMPLETED	19	58	0	0
Home Monitoring STARTED	0	0	93	110
Home Monitoring Started Physical Therapy	0	0	73	83
Home Monitoring Completed Post-Physical Therapy Assessments	0	0	64	62
Home Monitoring COMPLETED	0	0	64	62
Home Monitoring NOT COMPLETED	0	0	29	48

Reasons for withdrawal

Measure	Earlier Physical Therapy Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Later Physical Therapy (Standard of Care) Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Physical Therapy With Home Monitoring Wearable sensors were worn during home exercises and biofeedback was reviewed in the next physical therapy appointment.	Physical Therapy (Without Home Monitoring) Home exercise was completed without wearable sensors, and biofeedback was not given on home exercise performance.
Early and Late Physical Therapy Lost to Follow-up	2	18	0	0
Early and Late Physical Therapy Withdrawal by Subject	15	32	0	0
Early and Late Physical Therapy Early Termination - PI Decision	2	8	0	0
Home Monitoring Lost to Follow-up	0	0	8	12
Home Monitoring Withdrawal by Subject	0	0	17	30
Home Monitoring Early Termination - PI Decision	0	0	4	6

Baseline Characteristics

Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes in mTBI?

Baseline characteristics by cohort

Measure	Earlier Physical Therapy n=81 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant.	Total n=202 Participants Total of all reporting groups
Age, Continuous	35.6 years STANDARD_DEVIATION 11.6 • n=5 Participants	36.0 years STANDARD_DEVIATION 11.2 • n=7 Participants	35.9 years STANDARD_DEVIATION 11.3 • n=5 Participants
Sex/Gender, Customized Sex/Gender · Male	18 Participants n=5 Participants	20 Participants n=7 Participants	38 Participants n=5 Participants
Sex/Gender, Customized Sex/Gender · Female	63 Participants n=5 Participants	96 Participants n=7 Participants	159 Participants n=5 Participants
Sex/Gender, Customized Sex/Gender · Other	0 Participants n=5 Participants	5 Participants n=7 Participants	5 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	1 Participants n=5 Participants	2 Participants n=7 Participants	3 Participants n=5 Participants
Race (NIH/OMB) Asian	2 Participants n=5 Participants	2 Participants n=7 Participants	4 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	2 Participants n=5 Participants	2 Participants n=7 Participants	4 Participants n=5 Participants
Race (NIH/OMB) Black or African American	1 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants
Race (NIH/OMB) White	65 Participants n=5 Participants	98 Participants n=7 Participants	163 Participants n=5 Participants
Race (NIH/OMB) More than one race	5 Participants n=5 Participants	13 Participants n=7 Participants	18 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	5 Participants n=5 Participants	3 Participants n=7 Participants	8 Participants n=5 Participants
Region of Enrollment United States	81 participants n=5 Participants	121 participants n=7 Participants	202 participants n=5 Participants
Body Mass Index	25.1 kg/m2 STANDARD_DEVIATION 4.9 • n=5 Participants	27.3 kg/m2 STANDARD_DEVIATION 8.0 • n=7 Participants	26.4 kg/m2 STANDARD_DEVIATION 7.0 • n=5 Participants
Days Since Injury at Enrollment	45.9 days STANDARD_DEVIATION 20.1 • n=5 Participants	45.4 days STANDARD_DEVIATION 22.4 • n=7 Participants	45.6 days STANDARD_DEVIATION 21.5 • n=5 Participants
Injury Mechanism bike-related	3 Participants n=5 Participants	6 Participants n=7 Participants	9 Participants n=5 Participants
Injury Mechanism fall	17 Participants n=5 Participants	23 Participants n=7 Participants	40 Participants n=5 Participants
Injury Mechanism motor vehicle accident	24 Participants n=5 Participants	47 Participants n=7 Participants	71 Participants n=5 Participants
Injury Mechanism other	19 Participants n=5 Participants	28 Participants n=7 Participants	47 Participants n=5 Participants
Injury Mechanism sport-related	18 Participants n=5 Participants	17 Participants n=7 Participants	35 Participants n=5 Participants
mild traumatic brain injury (mTBI) History No	43 Participants n=5 Participants	57 Participants n=7 Participants	100 Participants n=5 Participants
mild traumatic brain injury (mTBI) History Yes	38 Participants n=5 Participants	64 Participants n=7 Participants	102 Participants n=5 Participants

PRIMARY outcome

Timeframe: Earlier Physical Therapy (PT) Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Self-rated questionnaire for dizziness impairment rated on a 3-point scale (0: no; 2: sometimes; 4: always) with a maximum score of 100. Higher scores indicate worse outcome.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Dizziness Handicap Inventory (DHI) Estimated Mean at Enrollment	29.2 score on a scale Interval 25.4 to 33.0	34.9 score on a scale Interval 31.4 to 38.4	33.3 score on a scale Interval 29.5 to 37.1	32.1 score on a scale Interval 28.3 to 35.9
Dizziness Handicap Inventory (DHI) Estimated Change per Day	-0.202 score on a scale Interval -0.272 to -0.132	-0.105 score on a scale Interval -0.137 to -0.073	-0.133 score on a scale Interval -0.177 to -0.09	-0.102 score on a scale Interval -0.145 to -0.06

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Self-rated questionnaire (~5 minutes) for symptom severity on a scale from 0 (none) to 4 (very severe) with a maximum score of 88. High scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Neurobehavioral Symptom Inventory (NSI) Estimated Mean at Enrollment	39.1 score on a scale Interval 36.3 to 41.9	43.5 score on a scale Interval 41.1 to 45.9	42.7 score on a scale Interval 39.9 to 45.5	40.9 score on a scale Interval 38.3 to 43.5
Neurobehavioral Symptom Inventory (NSI) Estimated Change per Day	-0.259 score on a scale Interval -0.311 to -0.207	-0.186 score on a scale Interval -0.21 to -0.162	-0.23 score on a scale Interval -0.235 to -0.17	-0.189 score on a scale Interval -0.221 to -0.158

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Self-rated questionnaire for quality of life questioning satisfaction on a scale from 0 (not at all) to 4 (very). Scores are transformed to a scale of 0 to 100. Lower scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Quality of Life After Brain Injury (QOLIBRI) Estimated Mean at Enrollment	49.7 Percent Interval 46.5 to 52.9	45.7 Percent Interval 43.1 to 48.3	47.9 Percent Interval 44.6 to 51.2	46.8 Percent Interval 44.2 to 49.4
Quality of Life After Brain Injury (QOLIBRI) Estimated Change per Day	0.277 Percent Interval 0.209 to 0.345	0.179 Percent Interval 0.148 to 0.21	0.201 Percent Interval 0.159 to 0.242	0.192 Percent Interval 0.152 to 0.232

SECONDARY outcome

Timeframe: Earlier PT Group: Post PT (week 7) / Later PT Group: Post PT (week 14)

This single questionnaire will ask the participant to rate how they perceive their health has changed over the course of treatment. Scores range from 1 to 7 with lower scores indicating worse performance.

Outcome measures

Measure	Earlier Physical Therapy n=63 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=63 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=64 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=62 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Patient Global Impression of Change (PGIC)	6 score on a scale Interval 5.0 to 7.0	6 score on a scale Interval 5.0 to 7.0	6 score on a scale Interval 5.0 to 7.0	6 score on a scale Interval 5.0 to 7.0

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

One question asking participants how recovered they feel on a 0 (not at all recovered) to 100% (fully recovered and returned to pre-injury level) scale. Lower scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Return to Activity Question Estimated Mean at Enrollment	59.8 Percent (%) Interval 55.9 to 63.7	54.2 Percent (%) Interval 50.4 to 58.1	54.1 Percent (%) Interval 48.9 to 58.9	58.5 Percent (%) Interval 54.8 to 62.2
Return to Activity Question Estimated Change per Day	0.277 Percent (%) Interval 0.182 to 0.372	0.236 Percent (%) Interval 0.192 to 0.281	0.266 Percent (%) Interval 0.208 to 0.324	0.224 Percent (%) Interval 0.169 to 0.279

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Pre (week 7), and Post Physical Therapy (week 14)

Physical assessment that assesses gaze stability during head rotations (horizontal and vertical) relative to head-stationary visual acuity. Higher scores indicate worse outcome.

Outcome measures

Measure	Earlier Physical Therapy n=74 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=79 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=72 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=80 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Dynamic Visual Acuity (DVA) Pre Physical Therapy Horizonal DVA Lines Lost	1.1 lines lost from static visual acuity Interval 0.5 to 1.6	1.3 lines lost from static visual acuity Interval 0.7 to 1.8	1.4 lines lost from static visual acuity Interval 1.0 to 1.8	1.4 lines lost from static visual acuity Interval 1.1 to 1.7
Dynamic Visual Acuity (DVA) Pre Physical Therapy Vertical DVA Lines Lost	1.3 lines lost from static visual acuity Interval 0.8 to 1.8	1.1 lines lost from static visual acuity Interval 0.7 to 1.6	1.5 lines lost from static visual acuity Interval 1.0 to 1.9	1.2 lines lost from static visual acuity Interval 1.0 to 1.4
Dynamic Visual Acuity (DVA) Post Physical Therapy Vertical DVA Lines Lost	0.6 lines lost from static visual acuity Interval 0.1 to 1.2	0.9 lines lost from static visual acuity Interval 0.4 to 1.4	0.9 lines lost from static visual acuity Interval 0.7 to 1.2	0.9 lines lost from static visual acuity Interval 0.6 to 1.2
Dynamic Visual Acuity (DVA) Post Physical Therapy Horizonal DVA Lines Lost	0.8 lines lost from static visual acuity Interval 0.2 to 1.4	0.8 lines lost from static visual acuity Interval 0.3 to 1.3	0.9 lines lost from static visual acuity Interval 0.7 to 1.2	1.1 lines lost from static visual acuity Interval 0.8 to 1.5

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Physical assessment (~10 minutes) to assess the function of the vestibular- and ocular-motor system, and clinically reporting symptoms of headache, dizziness, nausea, and fogginess during each visual task on a 10-point scale (0: no symptoms; 10 severe symptoms). The total symptom provocation change scores range from 0 to 280. High scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Vestibular/Ocular-Motor Screening (VOMS) Tool Estimated Mean at Enrollment	14.4 score on a scale Interval 11.7 to 17.1	14.6 score on a scale Interval 12.6 to 16.6	14.9 score on a scale Interval 12.5 to 17.2	14.3 score on a scale Interval 11.8 to 16.8
Vestibular/Ocular-Motor Screening (VOMS) Tool Estimated Change per Day	-0.131 score on a scale Interval -0.188 to -0.074	-0.103 score on a scale Interval -0.129 to -0.077	-0.091 score on a scale Interval -0.125 to -0.056	-0.116 score on a scale Interval -0.149 to -0.083

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Physical assessment (~20 minutes) to quantify balance and clinically scored on a 3-point scale (0: severe; 2: normal) with a maximum score of 28. Lower scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Mini-Balance Evaluation Systems Test (Mini-BESTest) Estimated Mean at Enrollment	24.8 score on a scale Interval 24.3 to 25.3	24.4 score on a scale Interval 24.0 to 24.8	24.4 score on a scale Interval 23.8 to 24.9	24.7 score on a scale Interval 24.3 to 25.1
Mini-Balance Evaluation Systems Test (Mini-BESTest) Estimated Change per Day	0.019 score on a scale Interval 0.009 to 0.029	0.011 score on a scale Interval 0.006 to 0.015	0.011 score on a scale Interval 0.005 to 0.017	0.013 score on a scale Interval 0.008 to 0.019

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Physical assessment (~5 min) that is clinically scored on a scale from 0-10 (0: no errors; 10: 10 or more errors) for each of the three conditions. High scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Modified Balance Error Scoring System (mBESS) Estimated Mean at Enrollment	6.1 score on a scale Interval 4.9 to 7.4	6.6 score on a scale Interval 5.5 to 7.6	6.6 score on a scale Interval 5.2 to 7.9	6.2 score on a scale Interval 5.2 to 7.3
Modified Balance Error Scoring System (mBESS) Estimated Change per Day	-0.0229 score on a scale Interval -0.0459 to 0.00021	-0.0122 score on a scale Interval -0.0226 to -0.0018	0.0003 score on a scale Interval -0.013 to 0.0135	-0.024 score on a scale Interval -0.037 to -0.011

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

20-minute Computer-based test of cognition. Composite scores range from -4 to +4. Lower scores indicate worse outcome.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Automated Neuropsychological Assessment Metrics (ANAM) Estimated Change per Day	0.00647 score on a scale Interval 0.00243 to 0.0105	0.00256 score on a scale Interval 0.000716 to 0.0044	0.0028 score on a scale Interval 0.0003 to 0.0053	0.0034 score on a scale Interval 0.0011 to 0.0057
Automated Neuropsychological Assessment Metrics (ANAM) Estimated Mean at Enrollment	-0.730 score on a scale Interval -0.933 to -0.527	-0.732 score on a scale Interval -0.922 to -0.543	-0.787 score on a scale Interval -0.985 to -0.588	-0.685 score on a scale Interval -0.892 to -0.478

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Two participants fell during EcFo test making the sway area invalid.

Participants stand with feet together with eyes closed on a firm (EcFi) and Foam (EcFo) surface for 30 seconds. An inertial sensor around the waist measures the sway area. Larger areas indicate worse performance.We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Instrumented Sway Estimated EcFi Sway Area Change per Day	-0.006 m^4/s^2 Interval -0.01 to -0.001	-0.003 m^4/s^2 Interval -0.005 to -0.001	-0.0004 m^4/s^2 Interval -0.0013 to 0.0005	-0.0008 m^4/s^2 Interval -0.0017 to 0.0001
Instrumented Sway Estimated EcFo Sway Area	-0.008 m^4/s^2 Interval -0.011 to -0.005	-0.003 m^4/s^2 Interval -0.004 to -0.001	-0.0021 m^4/s^2 Interval -0.0041 to -0.0002	-0.0032 m^4/s^2 Interval -0.0051 to -0.0013
Instrumented Sway Estimated Mean EcFi Sway Area at Enrollment	0.160 m^4/s^2 Interval 0.128 to 0.192	0.237 m^4/s^2 Interval 0.16 to 0.314	0.215 m^4/s^2 Interval 0.145 to 0.286	0.198 m^4/s^2 Interval 0.129 to 0.267
Instrumented Sway Estimated Mean EcFo Sway Area at Enrollment	0.816 m^4/s^2 Interval 0.394 to 1.238	0.654 m^4/s^2 Interval 0.546 to 0.762	0.687 m^4/s^2 Interval 0.554 to 0.82	0.747 m^4/s^2 Interval 0.419 to 1.075

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Physical assessment using wearable inertial sensors to quantify the average time to navigate a lap of a complex course (total 8 laps). Participants walk at a self-selected pace around the course under single-task and dual-task auditory Stroop conditions. Longer lap times indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Complex Navigation Task Estimated Mean Single Task Average Lap Time at Enrollment	14.78 Seconds Interval 14.16 to 15.39	15.30 Seconds Interval 14.85 to 15.75	14.94 Seconds Interval 14.36 to 15.52	15.22 Seconds Interval 14.72 to 15.73
Complex Navigation Task Estimated Mean Auditory Stroop Task Average Lap Time at Enrollment	14.76 Seconds Interval 14.19 to 15.34	15.40 Seconds Interval 14.92 to 15.88	14.99 Seconds Interval 14.38 to 15.6	15.27 Seconds Interval 14.77 to 15.78
Complex Navigation Task Estimated Auditory Stroop Task Average Lap Time Change per Day	-0.0300 Seconds Interval -0.0393 to -0.0208	-0.0190 Seconds Interval -0.023 to -0.015	-0.022 Seconds Interval -0.027 to -0.017	-0.022 Seconds Interval -0.027 to -0.016
Complex Navigation Task Estimated Single Task Average Lap Time Change per Day	-0.0322 Seconds Interval -0.0421 to -0.0223	-0.0210 Seconds Interval -0.0253 to -0.0168	-0.022 Seconds Interval -0.028 to -0.0165	-0.024 Seconds Interval -0.03 to -0.019

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: 1 Participant from the Later PT group was excluded from Single Task 180 Deg Turn Velocity because of not following directions correctly.

Physical assessment using wearable inertial sensors to quantify gait kinematics when walking at a self-selected pace in a straight line (9m) with and without the auditory Stroop. Gait speed at enrollment (m/s). Slower gait speeds and slower turning velocity indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Instrumented Walking: Gait Speed Estimated Change in Single Task Gait Speed per Day	0.00083 m/s Interval 0.0003 to 0.00136	0.00054 m/s Interval 0.00031 to 0.00077	0.00062 m/s Interval 0.0003 to 0.00093	0.00063 m/s Interval 0.00032 to 0.00093
Instrumented Walking: Gait Speed Estimated Mean Auditory Stroop Gait Speed at Enrollment	1.277 m/s Interval 1.243 to 1.311	1.227 m/s Interval 1.195 to 1.259	1.244 m/s Interval 1.204 to 1.284	1.263 m/s Interval 1.231 to 1.295
Instrumented Walking: Gait Speed Estimated Change in Auditory Stroop Gait Speed per Day	0.00083 m/s Interval 0.00032 to 0.00134	0.00049 m/s Interval 0.00026 to 0.00071	0.00058 m/s Interval 0.00028 to 0.00089	0.00060 m/s Interval 0.0003 to 0.00089
Instrumented Walking: Gait Speed Estimated Mean Single Task Gait Speed at Enrollment	1.313 m/s Interval 1.279 to 1.348	1.255 m/s Interval 1.225 to 1.286	1.289 m/s Interval 1.252 to 1.326	1.283 m/s Interval 1.251 to 1.341

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: 1 Participant from the Later PT group was excluded from Single Task 180 Deg Turn Velocity because of not following directions correctly.

Physical assessment using wearable inertial sensors to quantify gait kinematics when walking at a self-selected pace in a straight line (9m) with and without the auditory Stroop. Measure: 180-degree turning speed. Slower turning velocities indicate worse outcomes. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Instrumented Walking: 180 Degree Turn Velocity Estimated Mean Single Task 180 Degree Turn Velocity at Enrollment	208.22 degrees per second Interval 199.42 to 217.03	194.78 degrees per second Interval 187.72 to 201.84	201.2 degrees per second Interval 191.6 to 210.7	199.4 degrees per second Interval 192.3 to 206.5
Instrumented Walking: 180 Degree Turn Velocity Estimated Change in Single Task 180 Degree Turn Velocity per Day	0.261 degrees per second Interval 0.0999 to 0.422	0.100 degrees per second Interval 0.0275 to 0.173	0.1263 degrees per second Interval 0.0153 to 0.2372	0.1841 degrees per second Interval 0.077 to 0.2911
Instrumented Walking: 180 Degree Turn Velocity Estimated Mean Auditory Stroop 180 Degree Turn Velocity at Enrollment	204.23 degrees per second Interval 195.82 to 212.64	193.13 degrees per second Interval 185.54 to 200.73	197.0 degrees per second Interval 187.6 to 206.3	198.2 degrees per second Interval 190.7 to 205.8
Instrumented Walking: 180 Degree Turn Velocity Estimated Change in Auditory Stroop 180 Degree Turn Velocity per Day	0.306 degrees per second Interval 0.152 to 0.461	0.0897 degrees per second Interval 0.0211 to 0.158	0.1801 degrees per second Interval 0.0904 to 0.2697	0.1099 degrees per second Interval 0.0231 to 0.1967

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: 1 Participant from the Later PT group was excluded from Single Task 180 Deg Turn Velocity because of not following directions correctly.

Physical assessment using wearable inertial sensors to quantify gait kinematics when walking at a self-selected pace in a straight line (9m) with and without the auditory Stroop. Percentage of gait cycle in double support were the outcome measure. Larger percentages of double support time indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Instrumented Walking: Percentage of Double Support of Gait Cycle Estimated Change in Auditory Stroop Percentage of Double Support of Gait Cycle per Day	-0.00278 % of Gait Cycle Interval -0.0117 to 0.00612	-0.0018 % of Gait Cycle Interval -0.0057 to 0.00205	-0.0029 % of Gait Cycle Interval -0.0079 to 0.002	-0.0022 % of Gait Cycle Interval -0.0071 to 0.0026
Instrumented Walking: Percentage of Double Support of Gait Cycle Estimated Mean Single Task Percentage of Double Support of Gait Cycle at Enrollment	19.18 % of Gait Cycle Interval 18.57 to 19.79	20.08 % of Gait Cycle Interval 19.44 to 20.72	19.88 % of Gait Cycle Interval 19.16 to 20.59	19.59 % of Gait Cycle Interval 18.94 to 20.23
Instrumented Walking: Percentage of Double Support of Gait Cycle Estimated Change in Single Task Percentage of Double Support of Gait Cycle per Day	-0.0021 % of Gait Cycle Interval -0.0104 to 0.00614	-0.0027 % of Gait Cycle Interval -0.0063 to 0.00082	-0.0041 % of Gait Cycle Interval -0.0089 to 0.00068	-0.0015 % of Gait Cycle Interval -0.0061 to 0.0032
Instrumented Walking: Percentage of Double Support of Gait Cycle Estimated Mean Auditory Stroop Percentage of Double Support of Gait Cycle at Enrollment	19.77 % of Gait Cycle Interval 19.14 to 20.39	20.59 % of Gait Cycle Interval 19.92 to 21.26	20.61 % of Gait Cycle Interval 19.85 to 21.36	19.96 % of Gait Cycle Interval 19.31 to 20.61

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to calculate sensory weighting. This outcome is unitless for the weights as they are percentage values (0-1). We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Visual and Vestibular Weighting Estimated Mean Visual Weighting (VS/EO) at Enrollment	0.134 unitless (% of sensory system of balance Interval 0.121 to 0.147	0.133 unitless (% of sensory system of balance Interval 0.122 to 0.144	0.137 unitless (% of sensory system of balance Interval 0.124 to 0.15	0.130 unitless (% of sensory system of balance Interval 0.118 to 0.142
Central Sensorimotor Integration (CSMI) Test: Visual and Vestibular Weighting Estimated Visual Weighting (VS/EO) Change per Day	-0.0004 unitless (% of sensory system of balance Interval -0.0006 to -0.0002	-0.0002 unitless (% of sensory system of balance Interval -0.0003 to -0.0001	-0.00025 unitless (% of sensory system of balance Interval -0.00037 to -0.00013	-0.00021 unitless (% of sensory system of balance Interval -0.00033 to -0.00009
Central Sensorimotor Integration (CSMI) Test: Visual and Vestibular Weighting Estimated Mean Vestibular Weighting (SS+VS/EO) at Enrollment	0.414 unitless (% of sensory system of balance Interval 0.393 to 0.435	0.415 unitless (% of sensory system of balance Interval 0.401 to 0.429	0.413 unitless (% of sensory system of balance Interval 0.393 to 0.434	0.416 unitless (% of sensory system of balance Interval 0.4 to 0.432
Central Sensorimotor Integration (CSMI) Test: Visual and Vestibular Weighting Estimated Vestibular Weighting (SS+VS/EO) Change per Day	0.0004 unitless (% of sensory system of balance Interval 0.0001 to 0.0008	0.0004 unitless (% of sensory system of balance Interval 0.0002 to 0.0005	0.00033 unitless (% of sensory system of balance Interval 0.00012 to 0.00054	0.00041 unitless (% of sensory system of balance Interval 0.00021 to 0.00062

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to calculate time delay within the neural controller. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Time Delay Estimated Time Delay (VS/EO) Change per Day	-0.217 ms Interval -0.33 to -0.104	0.018 ms Interval -0.036 to 0.073	-0.043 ms Interval -0.115 to 0.028	-0.0257 ms Interval -0.095 to 0.043
Central Sensorimotor Integration (CSMI) Test: Time Delay Estimated Mean Time Delay (VS/EO) at Enrollment	218.0 ms Interval 211.5 to 224.5	211.0 ms Interval 206.7 to 215.3	213.6 ms Interval 207.1 to 220.0	214.2 ms Interval 209.2 to 219.2
Central Sensorimotor Integration (CSMI) Test: Time Delay Estimated Mean Time Delay (SS+VS/EO) at Enrollment	171.0 ms Interval 165.6 to 176.4	170.0 ms Interval 166.6 to 173.4	169.5 ms Interval 164.6 to 174.4	171.9 ms Interval 167.6 to 176.2
Central Sensorimotor Integration (CSMI) Test: Time Delay Estimated Time Delay (SS+VS/EO) Change per Day	-0.169 ms Interval -0.25 to -0.089	-0.027 ms Interval -0.069 to 0.015	-0.076 ms Interval -0.126 to -0.026	-0.049 ms Interval -0.098 to 0.0002

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to calculate normalized stiffness for neural controller. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Normalized Stiffness Estimated Mean Normalized Stiffness (VS/EO) at Enrollment	1.219 unitless (%) Interval 1.199 to 1.239	1.228 unitless (%) Interval 1.211 to 1.245	1.212 unitless (%) Interval 1.19 to 1.233	1.234 unitless (%) Interval 1.215 to 1.253
Central Sensorimotor Integration (CSMI) Test: Normalized Stiffness Estimated Normalized Stiffness (VS/EO) Change per Day	0.0001 unitless (%) Interval -0.0004 to 0.0005	-0.0002 unitless (%) Interval -0.0004 to -0.000005	-0.00011 unitless (%) Interval -0.00036 to 0.00015	-0.00017 unitless (%) Interval -0.0042 to 0.00007
Central Sensorimotor Integration (CSMI) Test: Normalized Stiffness Estimated Mean Normalized Stiffness (SS+VS/EO) at Enrollment	1.381 unitless (%) Interval 1.354 to 1.408	1.382 unitless (%) Interval 1.362 to 1.402	1.373 unitless (%) Interval 1.345 to 1.401	1.388 unitless (%) Interval 1.365 to 1.41
Central Sensorimotor Integration (CSMI) Test: Normalized Stiffness Estimated Normalized Stiffness (SS+VS/EO) Change per Day	0.0004 unitless (%) Interval -0.00002 to 0.0008	-0.0004 unitless (%) Interval -0.0005 to -0.0002	-0.000046 unitless (%) Interval -0.0003 to 0.00021	-0.000030 unitless (%) Interval -0.000055 to -0.000004

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to calculate normalized damping for neural controller. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Normalized Damping Estimated Mean Normalized Damping (VS/EO) at Enrollment	0.469 unitless (%) Interval 0.458 to 0.48	0.469 unitless (%) Interval 0.46 to 0.478	0.456 unitless (%) Interval 0.445 to 0.466	0.479 unitless (%) Interval 0.469 to 0.489
Central Sensorimotor Integration (CSMI) Test: Normalized Damping Estimated Normalized Damping (VS/EO) Change per Day	0.0001 unitless (%) Interval -0.0001 to 0.0003	-0.0001 unitless (%) Interval -0.0002 to 0.00005	0.000050 unitless (%) Interval -0.000086 to 0.000186	-0.00009 unitless (%) Interval -0.00022 to 0.00004
Central Sensorimotor Integration (CSMI) Test: Normalized Damping Estimated Mean Normalized Damping (SS+VS/EO) at Enrollment	0.491 unitless (%) Interval 0.478 to 0.504	0.496 unitless (%) Interval 0.485 to 0.507	0.485 unitless (%) Interval 0.47 to 0.499	0.501 unitless (%) Interval 0.49 to 0.513
Central Sensorimotor Integration (CSMI) Test: Normalized Damping Estimated Normalized Damping (SS+VS/EO) Change per Day	0.0002 unitless (%) Interval -0.00003 to 0.0005	-0.0002 unitless (%) Interval -0.0003 to -0.00004	0.000015 unitless (%) Interval -0.000014 to 0.000017	-0.000011 unitless (%) Interval -0.000026 to 0.000004

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to calculate evoked center-of-mass (CoM) sway. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Evoked CoM Sway Estimated Evoked CoM Sway (SS+VS/EO) Change per Day	-0.001 deg Interval -0.002 to -0.0003	0.0002 deg Interval -0.0002 to 0.001	-0.00036 deg Interval -0.00098 to 0.00026	-0.00049 deg Interval -0.00066 to 0.00056
Central Sensorimotor Integration (CSMI) Test: Evoked CoM Sway Estimated Mean Evoked CoM Sway (SS+VS/EO) at Enrollment	1.093 deg Interval 1.027 to 1.159	1.068 deg Interval 1.025 to 1.111	1.116 deg Interval 1.047 to 1.184	1.050 deg Interval 1.003 to 1.096
Central Sensorimotor Integration (CSMI) Test: Evoked CoM Sway Estimated Mean Evoked CoM Sway (VS/EO) at Enrollment	0.289 deg Interval 0.256 to 0.322	0.281 deg Interval 0.253 to 0.309	0.308 deg Interval 0.272 to 0.345	0.265 deg Interval 0.236 to 0.294
Central Sensorimotor Integration (CSMI) Test: Evoked CoM Sway Estimated Evoked CoM Sway (VS/EO) Change per Day	-0.004 deg Interval -0.006 to -0.002	-0.0004 deg Interval -0.001 to 0.001	-0.00029 deg Interval -0.00068 to 0.00009	-0.00014 deg Interval -0.00051 to 0.00023

SECONDARY outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Population: Some participants were not able to complete both conditions of the CSMI test.

Physical assessment (~45 min) to quantify sway response from a pseudo-random rotating visual surround stimulus on a fixed surface with eyes open (VS/EO) or from combined rotating visual surround and stance surface stimuli (SS+VS/EO) to internal sensory noise. We generated inverse probability weights using data from all subjects, thus the overall number of participants (not the number of participants without missing values) as the overall participants analyzed.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Central Sensorimotor Integration (CSMI) Test: Internal Sensory Noise Estimated Mean Internal Sensory Noise (VS/EO) at Enrollment	0.088 deg Interval 0.079 to 0.097	0.087 deg Interval 0.079 to 0.095	0.092 deg Interval 0.081 to 0.104	0.084 deg Interval 0.076 to 0.091
Central Sensorimotor Integration (CSMI) Test: Internal Sensory Noise Estimated Internal Sensory Noise (VS/EO) Change per Day	-0.003 deg Interval -0.006 to -0.0004	0.0002 deg Interval -0.001 to 0.002	0.000054 deg Interval -0.00011 to 0.00022	-0.000051 deg Interval -0.00021 to 0.0001
Central Sensorimotor Integration (CSMI) Test: Internal Sensory Noise Estimated Mean Internal Sensory Noise (SS+VS/EO) at Enrollment	0.136 deg Interval 0.125 to 0.147	0.126 deg Interval 0.117 to 0.135	0.135 deg Interval 0.123 to 0.147	0.127 deg Interval 0.116 to 0.137
Central Sensorimotor Integration (CSMI) Test: Internal Sensory Noise Estimated Internal Sensory Noise (SS+VS/EO) Change per Day	-0.003 deg Interval -0.005 to -0.001	-0.0005 deg Interval -0.001 to 0.001	0.0000097 deg Interval -0.0000172 to 0.0000192	-0.00030 deg Interval -0.00037 to -0.00027

OTHER_PRE_SPECIFIED outcome

Timeframe: Collected weekly throughout study duration (week 0 to week 14).

A weekly questionnaire assessing mTBI symptom severity over 14 weeks with 22 items rated from 0 (none) to 6 (severe). Total symptom severity score out of 132. High scores indicate worse performance.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Post-concussion Symptom Scale From the Sport Concussion Assessment (SCAT) Tool Version 5 Estimated Mean at Enrollment	56.5 score on a scale Interval 51.9 to 61.2	58.8 score on a scale Interval 54.7 to 62.8	59.0 score on a scale Interval 54.4 to 63.5	56.9 score on a scale Interval 52.8 to 61.1
Post-concussion Symptom Scale From the Sport Concussion Assessment (SCAT) Tool Version 5 Estimated Change per Day	-0.349 score on a scale Interval -0.398 to -0.3	-0.317 score on a scale Interval -0.358 to -0.276	-0.361 score on a scale Interval -0.414 to -0.308	-0.313 score on a scale Interval -0.374 to -0.252

OTHER_PRE_SPECIFIED outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Self-rated questionnaire (~5 minutes) to rate sleep as a potential covariate for recovery rated on a 5-point scale (0: none; 4: very severe) with a maximum score of 28. High scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Insomnia Severity Index (ISI) Estimated Mean at Enrollment	14.0 score on a scale Interval 12.7 to 15.3	16.1 score on a scale Interval 15.0 to 17.2	15.5 score on a scale Interval 14.2 to 16.8	15.0 score on a scale Interval 13.9 to 16.2
Insomnia Severity Index (ISI) Estimated Change per Day	-0.0725 score on a scale Interval -0.0977 to -0.0473	-0.0590 score on a scale Interval -0.0705 to -0.0474	-0.060 score on a scale Interval -0.076 to -0.045	-0.059 score on a scale Interval -0.073 to -0.044

OTHER_PRE_SPECIFIED outcome

Timeframe: Earlier PT Group: Pre (week 0) and Post Physical Therapy (week 7) / Later PT Group: Baseline (week 0), Pre (week 7), and Post Physical Therapy (week 14)

Self-rated questionnaire (~5 minutes of 6 items to rate headache severity as a potential covariate for recovery rated on a 5-point scale (6: never; 13: always) with a maximum score of 78. High scores indicate worse outcomes.

Outcome measures

Measure	Earlier Physical Therapy n=82 Participants Within a week of enrollment and baseline testing, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the sensor data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Later Physical Therapy (Standard of Care) n=121 Participants Participants will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. After waiting, participants will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each physical therapy session will last 60 minutes and consist of cardiovascular exercise, cervical spine exercises, and vestibular therapy exercises (static and dynamic balance). Participants perform daily home exercises for approximately 30 minutes with similar subcategories from the in-person physical therapy sessions. Both the in-person physical therapy and home exercises will be individualized and progressive in the sense that each exercise can increase the level of difficulty at the discretion of the physical therapist depending on the performance of the participant. Two sub-arms include "Vestibular Rehabilitation" n=40, and "Vestibular Rehabilitation with Home Monitoring" n=40 The group allocated to vestibular rehabilitation with home monitoring will perform the vestibular home exercises while wearing one wireless sensor on the head and one on the sternum. When the participant brings the sensors into the physical therapy session each week, the physical therapist will examine the home data and likely make a more informed decision as to whether or not to increase the level of difficulty of the exercises.	Physical Therapy With Home Monitoring n=93 Participants Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 Participants Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Head Impact Test (HIT) - 6 Estimated Mean at Enrollment	61.7 score on a scale Interval 60.3 to 63.2	62.5 score on a scale Interval 61.4 to 63.7	62.4 score on a scale Interval 61.0 to 63.8	62.0 score on a scale Interval 60.8 to 63.2
Head Impact Test (HIT) - 6 Estimated Change per Day	-0.123 score on a scale Interval -0.156 to -0.0885	-0.0819 score on a scale Interval -0.0975 to -0.0663	-0.110 score on a scale Interval -0.13 to -0.09	-0.076 score on a scale Interval -0.096 to -0.056

Adverse Events

Earlier Physical Therapy

Serious events: 0 serious events

Other events: 3 other events

Deaths: 0 deaths

Later Physical Therapy (Standard of Care)

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Physical Therapy With Home Monitoring

Serious events: 0 serious events

Other events: 2 other events

Deaths: 0 deaths

Physical Therapy (Without Home Monitoring)

Serious events: 0 serious events

Other events: 1 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Measure	Earlier Physical Therapy n=82 participants at risk Within a week of enrollment and baseline testing, participants (n=80) will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Timing of Rehabilitation: Participants in the Earlier Physical Therapy group will start physical therapy within a week of enrollment and baseline testing. Participants allocated to the Later Physical Therapy group will wait 6 weeks after enrollment and baseline testing before starting physical therapy, and re-test on study outcomes before starting physical therapy. Both groups will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each session will last 60 minutes and consist of cardiovascular, cervical spine, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for 30 minutes with similar subcategories from the in-person sessions. Both the in-person physical therapy and home exercises will be individualized and progressive at the discretion of the physical therapist depending on the performance of the participant.	Later Physical Therapy (Standard of Care) n=121 participants at risk Participants (n=80) will wait 6 weeks after enrollment and baseline testing before starting physical therapy. Before starting physical therapy participants will be re-tested on study outcomes. Timing of Rehabilitation: Participants in the Earlier Physical Therapy group will start physical therapy within a week of enrollment and baseline testing. Participants allocated to the Later Physical Therapy group will wait 6 weeks after enrollment and baseline testing before starting physical therapy, and re-test on study outcomes before starting physical therapy. Both groups will see a physical therapist in person twice per week for 2 weeks and once per week for 4 weeks for a total of 8 sessions over 6 weeks. Each session will last 60 minutes and consist of cardiovascular, cervical spine, and vestibular therapy exercises (static and dynamic balance). Participants will perform daily home exercises for 30 minutes with similar subcategories from the in-person sessions. Both the in-person physical therapy and home exercises will be individualized and progressive at the discretion of the physical therapist depending on the performance of the participant.	Physical Therapy With Home Monitoring n=93 participants at risk Participants started physical therapy after baseline testing and used wearable sensors during home exercises. Feedback was provided later at the next physical therapy session.	Physical Therapy (Without Home Monitoring) n=110 participants at risk Participants started physical therapy after baseline testing and did not use wearable sensors during home exercises. No feedback of performance was provided.
Vascular disorders Medical Event: Nose bleed	1.2% 1/82 • Number of events 1 • Study duration (week 0 to week 14)	0.00% 0/121 • Study duration (week 0 to week 14)	0.00% 0/93 • Study duration (week 0 to week 14)	0.91% 1/110 • Number of events 1 • Study duration (week 0 to week 14)
Eye disorders Medical Event: Swelling of Eye	1.2% 1/82 • Number of events 1 • Study duration (week 0 to week 14)	0.00% 0/121 • Study duration (week 0 to week 14)	1.1% 1/93 • Number of events 1 • Study duration (week 0 to week 14)	0.00% 0/110 • Study duration (week 0 to week 14)
Musculoskeletal and connective tissue disorders Discomfort While Testing	1.2% 1/82 • Number of events 1 • Study duration (week 0 to week 14)	0.00% 0/121 • Study duration (week 0 to week 14)	1.1% 1/93 • Number of events 1 • Study duration (week 0 to week 14)	0.00% 0/110 • Study duration (week 0 to week 14)

Additional Information

Dr. Laurie King

Oregon Health and Science University

Phone: 5034182602

Email: kingla@ohsu.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place