Abstract
BackgroundConcussion diagnosis is typically made through clinical examination and supported by performance on clinical assessment tools. Performance on commonly implemented and emerging assessment tools is known to vary between administrations, in the absence of concussion.ObjectiveTo evaluate the test-retest reliability of commonly implemented and emerging concussion assessment tools across a large nationally representative sample of student-athletes.MethodsParticipants (n = 4874) from the Concussion Assessment, Research, and Education Consortium completed annual baseline assessments on two or three occasions. Each assessment included measures of self-reported concussion symptoms, motor control, brief and extended neurocognitive function, reaction time, oculomotor/oculovestibular function, and quality of life. Consistency between years 1 and 2 and 1 and 3 were estimated using intraclass correlation coefficients or Kappa and effect sizes (Cohen’s d). Clinical interpretation guidelines were also generated using confidence intervals to account for non-normally distributed data.ResultsReliability for the self-reported concussion symptoms, motor control, and brief and extended neurocognitive assessments from year 1 to 2 ranged from 0.30 to 0.72 while effect sizes ranged from 0.01 to 0.28 (i.e., small). The reliability for these same measures ranged from 0.34 to 0.66 for the year 1–3 interval with effect sizes ranging from 0.05 to 0.42 (i.e., small to less than medium). The year 1–2 reliability for the reaction time, oculomotor/oculovestibular function, and quality-of-life measures ranged from 0.28 to 0.74 with effect sizes from 0.01 to 0.38 (i.e., small to less than medium effects).ConclusionsThis investigation noted less than optimal reliability for most common and emerging concussion assessment tools. Despite this finding, their use is still necessitated by the absence of a gold standard diagnostic measure, with the ultimate goal of developing more refined and sound tools for clinical use. Clinical interpretation guidelines are provided for the clinician to apply with a degree of certainty in application.
Highlights
Multiple organizations suggest [1, 2] or endorse [3, 4] athletes engaging in sports that carry a concussion risk undergo a baseline evaluation prior to participation, against which to measure impairments resulting from injury
As the concussion diagnosis can only be made through a clinical examination, test reliability is of particular importance to the healthcare provider who does not know the true health status of the athlete and must rely on clinical measures to assist in the injury management process
Interpretation of intraclass correlation coefficients (ICCs) and Kappa scores vary in the literature with some suggesting that scores over 0.75 are representative of good reliability, while those less than 0.75 reflect moderate-topoor reliability [28]
Summary
Multiple organizations suggest [1, 2] or endorse [3, 4] athletes engaging in sports that carry a concussion risk undergo a baseline evaluation prior to participation, against which to measure impairments resulting from injury. The baseline assessment permits medical professionals caring for concussed athletes to apply individualized performance metrics when determining if the athlete is concussed and/or when to allow for a return to play. Important in this process is understanding the foundational psychometric properties of the clinical measures. State and trait variance precludes perfect stability, it is critical to know the degree of normal variation on a measure to determine clinically meaningful performance changes that can reliability be attributed to injury. Performance on commonly implemented and emerging assessment tools is known to vary between administrations, in the absence of concussion
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