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O'Halloran PJ, Kontos AP, Collins MW. Concussion and Sport: Progress is Evident. Sports Med 2022; 52:2803-2805. [PMID: 35723865 PMCID: PMC9585013 DOI: 10.1007/s40279-022-01713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Philip J O'Halloran
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.
- School of Physiotherapy, The Royal College of Surgeons in Ireland, Dublin, Ireland.
- UPMC Concussion Network, Waterford, Ireland.
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W Collins
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Li AY, Schupper AJ, Quinones A, Shuman WH, Ali M, Hannah TC, Durbin JR, Dreher N, Spiera Z, Marayati NF, Gometz A, Lovell MR, Choudhri TF. Sport Contact Level Affects Post-Concussion Neurocognitive Performance in Young Athletes. Arch Clin Neuropsychol 2021; 37:19-29. [PMID: 33829227 DOI: 10.1093/arclin/acab021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Contact level affects the incidence of sports-related concussion. However, the effects of contact level on injury severity and recovery are less clear and are the focus of this study. METHOD Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) for athletes aged 12-22 was performed at baseline (n = 10,907 for 7,058 athletes), after suspected concussion determined by physicians or athletic trainers (n = 5,062 for 4,419 athletes), and during follow-up visits (n = 3,264 for 2,098 athletes). Athletes played contact/collision (CC), limited contact (LC), and noncontact (NC) sports. Injury incidence, severity, and recovery were measured using raw and change from baseline neurocognitive test scores. Comparisons between groups used univariate analysis and multivariable regression controlling for demographic variables. RESULTS Compared to CC athletes, LC and NC athletes showed decreased suspected concussion incidence. At initial post-injury testing, all neurocognitive test scores were similar between groups except changes from baseline for processing speed were improved for LC compared to CC athletes. Upon follow-up testing, raw neurocognitive scores were better for NC compared to the contact collision athletes in verbal memory, processing speed, total symptom score, migraine cluster, cognitive cluster, and neuropsychiatric cluster scores. For change from baseline scores, LC athletes exhibited better performance on verbal memory, processing speed, and reaction time but also showed higher neuropsychiatric scores than CC athletes. CONCLUSION Neurocognitive scores between contact levels were similar at the first post-injury test. However, follow up showed many improved scores and symptoms for limited and NC sports compared to CC sports, which may indicate faster recovery.
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Affiliation(s)
- Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John R Durbin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nickolas Dreher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Concussion Management of New York, New York, NY, USA
| | - Mark R Lovell
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mason SJ, Davidson BS, Lehto M, Ledreux A, Granholm AC, Gorgens KA. A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test-Retest Reliability for Enhancing Student Athlete Safety. Arch Clin Neuropsychol 2020; 35:1131–1144. [PMID: 32853329 DOI: 10.1093/arclin/acaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE In this study we examined the temporal stability of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) within NCAA Division I athletes across various timepoints using an exhaustive series of statistical models. METHODS Within a cohort design, 48 athletes completed repeated baseline ImPACT assessments at various timepoints. Intraclass correlation coefficients (ICC) were calculated using a two-way mixed effects model with absolute agreement. RESULTS Four ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time) demonstrated moderate reliability (ICC = 0.51-0.66) across the span of a typical Division I athlete's career, which is below previous reliability recommendations (0.90) for measures used in individual decision-making. No evidence of fixed bias was detected within Verbal Memory, Visual Motor Speed, or Reaction Time composite scores, and minimal detectable change values exceeded the limits of agreement. CONCLUSIONS The demonstrated temporal stability of the ImPACT falls below the published recommendations, and as such, fails to provide robust support for the NCAA's recommendation to obtain a single preparticipation cognitive baseline for use in sports-related concussion management throughout an athlete's career. Clinical interpretation guidelines are provided for clinicians who utilize baseline ImPACT scores for later performance comparisons.
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Affiliation(s)
- Sara J Mason
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Bradley S Davidson
- Mechanical and Materials Engineering, University of Denver, Denver 80208, CO, USA
| | - Marybeth Lehto
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver, Denver 80208, CO, USA
| | | | - Kim A Gorgens
- Graduate School of Professional Psychology, University of Denver, Denver 80208, CO, USA
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Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
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Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
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Haider MN, Leddy JJ, Pavlesen S, Kluczynski M, Baker JG, Miecznikowski JC, Willer BS. A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. Br J Sports Med 2018; 52:1179-1190. [PMID: 28735282 PMCID: PMC5818323 DOI: 10.1136/bjsports-2016-096551] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions. DESIGN Systematic review. DATA SOURCES The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers. ELIGIBILITY CRITERIA Inclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures. EXCLUSION CRITERIA review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used. STUDY QUALITY Study quality was assessed using the Downs and Black Criteria. RESULTS Of 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case-control or cohort (level of evidence 4) and had significant risk of bias. CONCLUSION All studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.
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Affiliation(s)
- Mohammad N Haider
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
| | - John J Leddy
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Sonja Pavlesen
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Melissa Kluczynski
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - John G Baker
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Nuclear Medicine
| | | | - Barry S Willer
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
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Mang CS, Whitten TA, Cosh MS, Scott SH, Wiley JP, Debert CT, Dukelow SP, Benson BW. Test-retest reliability of the KINARM end-point robot for assessment of sensory, motor and neurocognitive function in young adult athletes. PLoS One 2018; 13:e0196205. [PMID: 29689075 PMCID: PMC5915777 DOI: 10.1371/journal.pone.0196205] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 04/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background Current assessment tools for sport-related concussion are limited by a reliance on subjective interpretation and patient symptom reporting. Robotic assessments may provide more objective and precise measures of neurological function than traditional clinical tests. Objective To determine the reliability of assessments of sensory, motor and cognitive function conducted with the KINARM end-point robotic device in young adult elite athletes. Methods Sixty-four randomly selected healthy, young adult elite athletes participated. Twenty-five individuals (25 M, mean age±SD, 20.2±2.1 years) participated in a within-season study, where three assessments were conducted within a single season (assessments labeled by session: S1, S2, S3). An additional 39 individuals (28M; 22.8±6.0 years) participated in a year-to-year study, where annual pre-season assessments were conducted for three consecutive seasons (assessments labeled by year: Y1, Y2, Y3). Forty-four parameters from five robotic tasks (Visually Guided Reaching, Position Matching, Object Hit, Object Hit and Avoid, and Trail Making B) and overall Task Scores describing performance on each task were quantified. Results Test-retest reliability was determined by intra-class correlation coefficients (ICCs) between the first and second, and second and third assessments. In the within-season study, ICCs were ≥0.50 for 68% of parameters between S1 and S2, 80% of parameters between S2 and S3, and for three of the five Task Scores both between S1 and S2, and S2 and S3. In the year-to-year study, ICCs were ≥0.50 for 64% of parameters between Y1 and Y2, 82% of parameters between Y2 and Y3, and for four of the five Task Scores both between Y1 and Y2, and Y2 and Y3. Conclusions Overall, the results suggest moderate-to-good test-retest reliability for the majority of parameters measured by the KINARM robot in healthy young adult elite athletes. Future work will consider the potential use of this information for clinical assessment of concussion-related neurological deficits.
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Affiliation(s)
- Cameron S. Mang
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- * E-mail:
| | - Tara A. Whitten
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Madeline S. Cosh
- WinSport Medicine Clinic, Winter Sport Institute, Calgary, Alberta, Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - J. Preston Wiley
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
| | - Chantel T. Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
| | - Brian W. Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- WinSport Medicine Clinic, Winter Sport Institute, Calgary, Alberta, Canada
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
- Canadian Sport Institute Calgary, Calgary, Alberta, Canada
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Sandel NK, Worts PR, Burkhart S, Henry L. Comparison of baseline ImPACT performance in amateur motocross riders to football and basketball athletes. Brain Inj 2018; 32:493-497. [PMID: 29381402 DOI: 10.1080/02699052.2018.1429020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PRIMARY OBJECTIVE The American Motorcyclist Association requires professional riders to undergo baseline computerized neurocognitive testing (CNT) using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test for concussion management. It is recommended this practice be expanded to the amateur level, but limited research has explored whether baseline testing is necessary for youth when normative data is available. This study evaluates the utility of baseline testing for amateur riders by comparing their performance to those of traditional youth sports comprising normative datasets. DESIGN/METHODS An cross-sectional study comparing amateur motocross (N = 100) riders matched by age and sex to football (N = 100) and basketball (N = 100) athletes performance on baseline ImPACT testing. RESULTS ANCOVAs revealed a significant medium effect of group on measures of visual motor speed (F = 11.25, p < 0.001) and reaction time (F = 13.61, p < 0.001). Post hoc analyses revealed that motocross riders were significantly slower compared to football and basketball athletes. There were no significant differences (p > .05) between sport on measures of memory or symptoms. CONCLUSIONS Youth motocross riders performed significantly slower on speed measures compared to football and basketball athletes, providing preliminary support for the expansion of baseline ImPACT testing to the amateur level.
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Affiliation(s)
- Natalie K Sandel
- a Department of Orthopaedic Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Phillip R Worts
- b Department of Nutrition, Food and Exercise Sciences , Florida State University , Tallahassee , FL , USA.,c Tallahassee Orthopedic Clinic , Tallahassee , FL , USA
| | - Scott Burkhart
- b Department of Nutrition, Food and Exercise Sciences , Florida State University , Tallahassee , FL , USA.,d Tallahassee Orthopedic Clinic Concussion Center , Tallahassee , FL , USA
| | - Luke Henry
- e Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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Brett BL, Solomon GS. Comparison of Neurocognitive Performance in Contact and Noncontact Nonconcussed High School Athletes Across a Two-Year Interval. Dev Neuropsychol 2017; 42:70-82. [PMID: 28452600 DOI: 10.1080/87565641.2016.1243114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Investigating short-term effects of subconcussive impacts on neurocognitive functioning, we employed a repeated measures multivariate model and regression-based measure to examine neurocognitive changes in 771 contact and noncontact high school athletes over a two-year period. Results reveal significant changes in Visual Motor Speed for both groups over a two-year period, with small effect sizes. According to regression-based measures, differences in contact sport athletes' expected Time 2 performances were significant for Visual Motor Speed, also with minimal effects. Results do not conclusively implicate subconcussive hits as the offending factor in differences observed, with gender and sport-type possibly contributing to the small effects.
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Affiliation(s)
- Benjamin L Brett
- a Department of Counseling, Educational Psychology and Research , The University of Memphis , Memphis , Tennessee
| | - Gary S Solomon
- b Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , Tennessee.,c Vanderbilt Sports Concussion Center , Nashville , Tennessee
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Brett BL, Solomon GS, Hill J, Schatz P. Two-year Test–Retest Reliability in High School Athletes Using the Four- and Two-Factor ImPACT Composite Structures: The Effects of Learning Disorders and Headache/Migraine Treatment History. Arch Clin Neuropsychol 2017; 33:216-226. [DOI: 10.1093/arclin/acx059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 06/08/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Benjamin L Brett
- Department of Counseling, Educational Psychology and Research, The University of Memphis, Memphis, TN, USA
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jennifer Hill
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
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Rogers SD, Smith PJ, Stephenson AJ, Erik Everhart D. A Retrospective Cross-Sectional and Longitudinal Study of the Effects of Age on CNS Vital Signs Scores in High-School Athletes. Sports Med 2017; 47:1893-1899. [PMID: 28236259 DOI: 10.1007/s40279-017-0686-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Current recommendations for concussion management acknowledge the importance of objective assessments of neuropsychological (NP) ability, and computerized NP assessments have been widely integrated into the concussion management protocols of high schools. The optimal intervals for baseline test administration in high-school athletes are currently uncertain. The ability to accurately detect subtle NP deficits is particularly important for high-school athletes, in which concussions are increasingly recognized for adverse effects to the developing brain. PURPOSE The aim of this study was to assess the pattern of change in neurocognitive test performance, as well as changes in different domains of NP functioning over time. METHODS Baseline computerized NP assessments were conducted at six high schools over 4 academic years using CNS Vital Signs, a battery consisting of seven well-established NP tests. Data were retrospectively examined for age differences in both cross-sectional (n = 3015) and longitudinal (n = 1221) analyses. RESULTS Moderate changes were observed across several NP domains over time (Cohen's d = 0.39-0.61), with the largest improvements observed in executive functioning (mean improvement 5.78, 95% confidence interval [CI] 5.41-6.14, p < 0.001), psychomotor speed (mean improvement 4.59, 95% CI 3.97-5.22, p < 0.001), cognitive flexibility (mean improvement 5.11, 95% CI 4.76-5.45, p < 0.001), and reaction time (mean improvement -12.44 ms, 95% CI -10.10 to -14.78, p < 0.001). Improvements in NP performance were most pronounced between the freshman and senior years. CONCLUSIONS There is an appreciable change that occurs each year of high school in one or more domains of an NP battery, with executive functioning indicating the greatest magnitude of change. Females performed better relative to males across all time points though males exhibited more substantial improvement over time.
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Affiliation(s)
- Sharon D Rogers
- East Carolina University, 245 Ward Sports Medicine Bldg, Greenville, NC, 27858, USA.
| | - Patrick J Smith
- Duke University Medical Center, DUMC 3119, Durham, NC, 27710, USA
| | | | - D Erik Everhart
- East Carolina University, 238 Rawl, Greenville, NC, 27858, USA
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Brett BL, Solomon GS. The influence of validity criteria on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test-retest reliability among high school athletes. J Clin Exp Neuropsychol 2016; 39:286-295. [PMID: 27585635 DOI: 10.1080/13803395.2016.1224322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Research findings to date on the stability of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Composite scores have been inconsistent, requiring further investigation. The use of test validity criteria across these studies also has been inconsistent. Using multiple measures of stability, we examined test-retest reliability of repeated ImPACT baseline assessments in high school athletes across various validity criteria reported in previous studies. METHOD A total of 1146 high school athletes completed baseline cognitive testing using the online ImPACT test battery at two time periods of approximately two-year intervals. No participant sustained a concussion between assessments. Five forms of validity criteria used in previous test-retest studies were applied to the data, and differences in reliability were compared. RESULTS Intraclass correlation coefficients (ICCs) ranged in composite scores from .47 (95% confidence interval, CI [.38, .54]) to .83 (95% CI [.81, .85]) and showed little change across a two-year interval for all five sets of validity criteria. Regression based methods (RBMs) examining the test-retest stability demonstrated a lack of significant change in composite scores across the two-year interval for all forms of validity criteria, with no cases falling outside the expected range of 90% confidence intervals. CONCLUSION The application of more stringent validity criteria does not alter test-retest reliability, nor does it account for some of the variation observed across previously performed studies. As such, use of the ImPACT manual validity criteria should be utilized in the determination of test validity and in the individualized approach to concussion management. Potential future efforts to improve test-retest reliability are discussed.
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Affiliation(s)
- Benjamin L Brett
- a Department of Counseling, Educational Psychology and Research , The University of Memphis , Memphis , TN , USA.,b Vanderbilt Sports Concussion Center , Nashville , TN , USA
| | - Gary S Solomon
- b Vanderbilt Sports Concussion Center , Nashville , TN , USA.,c Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , TN , USA
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