The Dynamic Exertion Test for Sport-Related Concussion: A Comparison of Athletes at Return-to-Play and Healthy Controls.

Abstract

To describe the Dynamic Exertion Test (EXiT) by comparing physiological, performance, and clinical outcomes between athletes medically cleared following sport-related concussion (SRC) and healthy controls. One hundred four (female = 41, 39.4%) participants (14-21y of age) including 52 medically cleared for return to play at 21.48 (15.40)days following SRC and 52 healthy athletes completed the EXiT involving (1) 12-minute aerobic component and (2) 18-minute dynamic component including 2 functional movement and 5 change-of-direction(COD) tasks. Physiological (heart rate and blood pressure), clinical (endorsed symptoms and rating of perceived exertion), and performance (COD-task completion time and errors) outcomes were collected throughout EXiT. Participants also completed the Postconcussion Symptom Scale and vestibular/ocular motor screening before EXiT. Independent-samples t tests were used to compare groups on resting heart rate and blood pressure, COD-task completion time, and Mann-Whitney U tests on Postconcussion Symptom Scale, vestibular/ocular motor screening, and EXiT symptoms, rating of perceived exertion, and errors. COD-task completion time and resting systolic blood pressure and heart rate were similar between groups (P > .05). SRC reported greater rating of perceived exertion during the aerobic component (P < .05) and lower total dizziness (P = .003) and total symptoms (P = .021) during EXiT and had lower near point of convergence distance (P < .001) and total symptoms (P = .007) for vestibular/ocular motor screening than healthy athletes. Physiological, performance, and clinical EXiT outcomes were equivocal between athletes at medical clearance following SRC and healthy controls. The multidomain EXiT may help to inform safe return-to-play decision making post-SRC.