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Twohey EE, Hasley IB, Shaeffer PJ, Ceremuga GA, Firkins SA, Stringer GC, Vaz Carneiro Filho MR, Hollman JH, Savica R, Finnoff JT. Mixed Martial Arts: Comparing the King-Devick and Sport Concussion Assessment Tool 5 in knockouts, technical knockouts and choke holds. Arch Rehabil Res Clin Transl 2023; 5:100301. [PMID: 38163040 PMCID: PMC10757192 DOI: 10.1016/j.arrct.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To compare validity indices of the King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5) for traumatic events in MMA, and to determine if perfusion events (alterations in consciousness as the result of choke holds) cause similar changes in KD/SCAT5 scores. Design A prospective cohort study in MMA fighters who completed KD and SCAT5 assessments before and after a match. Outcomes were categorized as non-event, traumatic event, or perfusion event. KD/SCAT5 changes were compared between all athletes. Participants One hundred forty MMA athletes (7 women, 133 men), mean age=27.1 ± 4.9 years. Intervention N/A. Main outcome measures King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5). Results Among the 140 athletes, 19 sustained traumatic and 15 perfusion events. Testing provided sensitivities/specificities of 21.05%/93.39% (KD) and 77.78%/52.99% (SCAT5) in detecting a traumatic event. KD and SCAT5 Symptom Severity scores differed between athletes with and without traumatic events (P=.041 and .014). KD and SCAT5 Symptoms Score changes were observed between athletes with and without traumatic events (P=.023 and .042). Neither KD nor SCAT5 differed significantly between athletes with and without perfusion events. Conclusions The KD test provides high specificity and the SCAT5 demonstrates reasonable sensitivity when detecting a traumatic event. Of the SCAT5, symptoms-related scores may most effectively identify a traumatic event. A traumatic event may cause KD/SCAT5 changes similar to a concussion, while perfusion events did not.
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Affiliation(s)
- Eric E. Twohey
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | - Patrick J. Shaeffer
- Department of Physical Medicine and Rehabilitation, UnityPoint Health, Des Moines, IA
| | - George A. Ceremuga
- Department of Physical Medicine and Rehabilitation, Avera Health, Sioux Falls, SD
| | - Stephen A. Firkins
- Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | | | | - John H. Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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Daly E, Pearce AJ, Finnegan E, Cooney C, McDonagh M, Scully G, McCann M, Doherty R, White A, Phelan S, Howarth N, Ryan L. An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:125. [PMID: 35818048 PMCID: PMC9275058 DOI: 10.1186/s13102-022-00514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022]
Abstract
Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00514-1.
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Affiliation(s)
- Ed Daly
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Alan J Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Emma Finnegan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Ciara Cooney
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Maria McDonagh
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Grainne Scully
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Michael McCann
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Rónán Doherty
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Adam White
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Simon Phelan
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Nathan Howarth
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland.
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Kelshaw PM, Cook NE, Terry DP, Iverson GL, Caswell SV. Child Sport Concussion Assessment Tool 5th Edition: Normative Reference Values in Demographically Diverse Youth. Clin J Sport Med 2022; 32:e126-e133. [PMID: 34009797 DOI: 10.1097/jsm.0000000000000921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Examine sociodemographic differences (gender, age, and language spoken at home) on baseline Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) scores and establish normative reference data for the Child SCAT5 among middle school student athletes. DESIGN Cross-sectional study. SETTING Nine middle schools in Virginia. PARTICIPANTS A sample of 1355 athletes playing competitive school-sponsored sports (ages 11-13, M = 12.3 ± 0.8; 40.1% girls, 59.9% boys) during the 2017 and 2018 school year. Certified athletic trainers administered the Child SCAT5 within the first 2 weeks of the sport season. INDEPENDENT VARIABLES Self-reported gender, age, and language spoken at home. MAIN OUTCOME MEASURES All Child SCAT5 outcome measures. RESULTS Gender, age, and language spoken at home were associated with Child SCAT5 scores, but the magnitude of differences was generally small. Specifically, girls endorsed more symptoms (girls: M = 8.4 ± 5.7, boys: M = 7.5 ± 5.7; P = 0.003) and greater symptom severity (girls: M = 11.6 ± 9.4, boys: M = 10.4 ± 9.3; P = 0.006) than boys and performed slightly better than boys on cognitive and balance tasks. Older students performed slightly better than younger students on tests of cognition (eg, SAC-C: 11-year-olds: M = 21.3 ± 2.1, 13-year-olds: M = 21.7 ± 2.1; P = 0.02). Total symptoms (P = 0.01), symptom severity (P = 0.01), immediate memory (P < 0.001), delayed recall (P = 0.001), and SAC-C total scores (P = 0.002) differed across language groups. CONCLUSIONS Gender, age, and language spoken in the home are associated with baseline scores on multiple components of the Child SCAT5 among middle school students, although the magnitudes of observed differences are small. Normative reference values are provided for clinicians when interpreting Child SCAT5 scores.
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Affiliation(s)
- Patricia M Kelshaw
- Athletic Training Program, Department of Kinesiology, University of New Hampshire, Durham, New Hampshire
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES), Institute for BioHealth Innovation, George Mason University, Manassas, Virginia
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Neuropsychology Outcome Assessment Laboratory, Center for Health and Rehabilitation Research, Charlestown, Massachusetts
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Charlestown, Massachusetts
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts; and
| | - Shane V Caswell
- Athletic Training Education Program, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, School of Kinesiology, Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project, George Mason University, Manassas, Virginia
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Clark G, Johnson NA, Saluja SS, Correa JA, Delaney JS. Do Mountain Bikers Know When They Have Had a Concussion and, Do They Know to Stop Riding? Clin J Sport Med 2021; 31:e414-e419. [PMID: 31895715 DOI: 10.1097/jsm.0000000000000819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish the prevalence of concussions in mountain bikers and to determine factors that increase their risk of concussion. Secondary objectives include determination of whether mountain bikers have undiagnosed concussions, continue to ride after experiencing concussion symptoms, and if they knowingly ride with a broken helmet. DESIGN Retrospective survey. SETTING Seven-day mountain bike stage race. PARTICIPANTS Two hundred nineteen mountain bikers. MAIN OUTCOME MEASURES Number of rider concussions diagnosed, number of riders experiencing concussion symptoms without diagnosed concussions, number of riders who continue to ride after experiencing a concussion symptom, and number of riders who rode with a broken helmet. INDEPENDENT VARIABLES The independent variables studied included age, gender, nationality, number of times riding in past year, style of riding (cross-country, downhill, or freeride), years mountain biking, years mountain bike racing, whether they are a sponsored cyclist, and whether they also ride a road bike. RESULTS Fifteen of 219 mountain bikers (6.9%) had a diagnosed concussion after being hit in the head while mountain biking within the past year, with older riders having a decreased risk [odds ratio (OR), 0.91; P = 0.04], and sponsored riders having a 5-fold increased risk compared with nonsponsored riders (OR, 4.20; P = 0.05). Twenty-eight riders (12.8%) experienced a concussion symptom without being diagnosed with a concussion and 67.5% of the riders who experienced a concussion symptom continued to ride afterward. Overall, 29.2% of riders reported riding with a broken helmet. CONCLUSIONS The yearly prevalence of diagnosed concussions in mountain bikers is 6.9%. More than one-third of mountain bikers do not recognize when they have had a concussion and continue riding after experiencing concussion symptoms or with a broken helmet. These behaviors increase their risk of worsening concussion symptoms and acquiring a second injury.
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Affiliation(s)
- Gregory Clark
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathalie A Johnson
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sanjeet S Saluja
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada; and
| | - J Scott Delaney
- Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- McGill Sport Medicine Clinic, McGill University, Montreal, Quebec, Canada
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Coscia A, Stolz U, Barczak C, Wright N, Mittermeyer S, Shams T, Epstein S, Kreitzer N. Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease. J Head Trauma Rehabil 2021; 36:E302-E311. [PMID: 33656471 DOI: 10.1097/htr.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS). SETTING Three US EDs. PARTICIPANTS A total of 272 ED patients with suspected concussion. DESIGN Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians. MAIN MEASURES The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression. RESULTS 68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (βa): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (βa: 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (βa: 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (βa: 1.6 per 6-hour increase; CI: 0.4, 2.8). CONCLUSION Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.
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Affiliation(s)
- Atticus Coscia
- Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio (Messrs Coscia and Barczak and Drs Stolz and Kreitzer); Jan Medical, Mountain View, California (Ms Wright and Dr Mittermeyer); Ballad Health, Johnson City, Tennessee (Dr Shams); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Dr Epstein); and Division of Neurocritical Care, University of Cincinnati Medical Center, Ohio (Dr Kreitzer)
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Theadom A, Hardaker N, Bray C, Siegert R, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Shaikh N, Bastos Gottgtroy R, Hume P. The Brain Injury Screening Tool (BIST): Tool development, factor structure and validity. PLoS One 2021; 16:e0246512. [PMID: 33539482 PMCID: PMC7861451 DOI: 10.1371/journal.pone.0246512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach's alpha. A principal components analysis explored the underlying factor structure. Spearman's correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6-8 years old using readability statistics. High concurrent validity was shown against the RPQ (r = 0.91) and SCAT-5 (r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
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Affiliation(s)
- Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- * E-mail:
| | - Natalie Hardaker
- Accident Compensation Corporation, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Charlotte Bray
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Siegert
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kevin Henshall
- Trauma Service, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katherine Forch
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Axis Sports Medicine, Auckland, New Zealand
| | | | - Doug King
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | | | - Sam Jewell
- Wellington Sports Med, Wellington, New Zealand
| | - Nusratnaaz Shaikh
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Renata Bastos Gottgtroy
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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Hänninen T, Parkkari J, Howell DR, Palola V, Seppänen A, Tuominen M, Iverson GL, Luoto TM. Reliability of the Sport Concussion Assessment Tool 5 baseline testing: A 2-week test-retest study. J Sci Med Sport 2020; 24:129-134. [PMID: 32868203 DOI: 10.1016/j.jsams.2020.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine short-term test-retest reliability of the Sport Concussion Assessment Tool 5 (SCAT5). DESIGN Longitudinal study. METHODS Sixty-two professional male ice hockey players (mean age=22.5, SD=3.2) completed a preseason baseline test twice over a two-week interval. Half of the players were tested by the same assessor on both testing sessions. Spearman's correlations (rs) were used to determine linear agreements, and Wilcoxon signed rank tests (sig r) were used to determine mean differences, between testing sessions. RESULTS Symptoms had high test-retest reliability (Score: rs=0.85, p<0.001, sig r p<0.001; Severity: rs=0.84, p<0.001, sig r p<0.001). The reliability coefficients for the SAC (rs=0.58, p<0.001, sig r: p=0.412), and mBESS (rs=0.40, p=0.001, sig r: p=0.607) were considerably lower than symptoms. More than half (52%) of the athletes reported at least one baseline symptom (Md=1, M=2.2, SD=3.3). The most commonly reported symptoms were fatigue or low energy and neck pain. The broad ranges of SAC total scores (range=28-45, Md=35, M=35.4, SD=4.2) and SAC test-retest change scores (range -7 to +11) were mostly due to variability on the memory performance, tested using 10-item word lists. The number of mBESS single leg stance errors (Md=1, Md 3.2, SD=4.0) was greater than Tandem stance errors (Md=0, Md=2.0, SD=3.6). CONCLUSIONS The two-week test-retest reliability of the SCAT5 baseline scores varied from moderate to high. However, there was considerable individual variability on the SAC and mBESS scores and most players have notable short-term fluctuation on performance even if uninjured. Recommendations for interpreting change on the SCAT5 are provided.
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Affiliation(s)
- Timo Hänninen
- Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Finland.
| | - Jari Parkkari
- Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Finland
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA
| | - Vili Palola
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Arttu Seppänen
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Markku Tuominen
- IIHF Medical Committee; Liiga/Finnish Ice Hockey Association; Medisport Inc, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, MassGeneral Hospital for Children™ Sport Concussion Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, USA
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Finland
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Vedung F, Hänni S, Tegner Y, Johansson J, Marklund N. Concussion incidence and recovery in Swedish elite soccer - Prolonged recovery in female players. Scand J Med Sci Sports 2020; 30:947-957. [PMID: 32100894 DOI: 10.1111/sms.13644] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 12/06/2019] [Accepted: 02/05/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Sport-related concussions are an increasingly recognized health problem. Soccer is the most popular sport in the world although recent studies on concussion incidence are scarce. Here, a nationwide prospective study on concussion incidence, symptom severity, risk factors, gender differences, and return-to-play after concussion was performed in 51 Swedish elite soccer teams during the 2017 season. METHODS In the 1st and 2nd soccer leagues for men and women, a Sport Concussion Assessment Tool (SCAT)-based questionnaire study was performed at preseason (baseline) and from 48 hours to 3 months post-concussion. RESULTS We followed 959 players (389 women, 570 men) for 25 146 player game hours (9867 hours for women, 15 279 hours for men). Concussion incidence (n = 36 concussions during the season) was 1.19/1000 player game hours (females 1.22/1000 hours, males 1.18/1000 hours; P = .85). Twenty-seven percent of all players (8% of females, 40% of males) continued to play immediately after the concussion. When compared to male players, female players had worse initial symptom severity scores (median and IQR 30 (17-50.5) vs 11 (4-26.25), P = .02) on SCAT and longer return-to-play (P = .02). Risk factors for concussion were baseline symptoms and previous concussion. CONCLUSION In Swedish elite soccer, the concussion incidence was 1.19/1000 without gender differences. Most players recovered to play within 4 weeks post-injury. Almost one third of players continued to play at time of concussion. Female players had worse initial symptoms and longer return-to-play time than males, and a prolonged recovery beyond 3 months was only observed among female players.
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Affiliation(s)
- Fredrik Vedung
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Sofie Hänni
- Department of Surgical Sciences, Anesthesiology, Uppsala University, Uppsala, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Jakob Johansson
- Department of Surgical Sciences, Anesthesiology, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences Lund, Neurosurgery, Skane University Hospital, Lund University, Lund, Sweden
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Identification of Postconcussion Dual-Task Gait Abnormalities Using Normative Reference Values. J Appl Biomech 2019; 35:290-296. [DOI: 10.1123/jab.2018-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to identify the rate of abnormal single-task and dual-task gait performance following concussion compared to uninjured controls using previously established normative reference values. The authors examined athletes with a concussion (n = 54; mean age = 20.3 [1.1] y, 46% female, tested 2.9 [1.5] d postinjury), and healthy controls were tested during their preseason baseline examination (n = 60; mean age = 18.9 [0.7] y, 37% female). Participants completed an instrumented single-/dual-task gait evaluation. Outcome variables included average walking speed, cadence, and step length. A significantly greater number of those with concussion walked with abnormal dual-task gait speed compared with the control group (56% vs 30%,P = .01). After adjusting for potential confounding variables (age, concussion history, symptom severity, and sleep), concussion was associated with lower dual-task gait speed (β = −0.150; 95% confidence interval [CI] = −0.252 to −0.047), cadence (β = −8.179; 95% CI = −14.49 to −1.871), and stride length (β = −0.109; 95% CI = −0.204 to −0.014). Although group analyses indicated that those with a concussion performed worse on single-task and dual-task gait compared with controls, a higher rate of abnormal gait was detected for the concussion group compared with the control group for dual-task gait speed only. Dual-task gait speed, therefore, may be considered as a measure to compare against normative values to detect postconcussion impairments.
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Mistry DA, Rainer TH. Concussion assessment in the emergency department: a preliminary study for a quality improvement project. BMJ Open Sport Exerc Med 2018; 4:e000445. [PMID: 30687512 PMCID: PMC6326330 DOI: 10.1136/bmjsem-2018-000445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/09/2022] Open
Abstract
Background In sport, concussion is assessed using the Sports Concussion Assessment Tool (SCAT) 5 and managed with return to play guidelines. Similar, user-friendly tools are rarely, if ever, used in the emergency department (ED). Objectives To evaluate a modified concussion assessment tool designed for the ED (ED-CAT) in patients presenting with a head injury and to identify variables that predict 30-day reattendance. Methods A preliminary, prospective, evaluation in a quality improvement project was conducted in one hospital in South Wales. Patients were recruited if they were over 13 years, and either did not have an ED-CT head scan or had a scan with no acute changes. The primary outcome was 30-day reattendance. Results 40 patients were recruited, 18 of whom had a CT scan. 37 were discharged on the same day with advice, two discharged the next day and one was admitted. Three (7.5%) patients reattended the department. Predictors of reattendance were headache score (median 3.0 vs 5.0; p<0.05), pressure in head score (2.0 vs 5.0; p<0.05), nausea/vomiting score (1.0 vs 3.0; p<0.05), dizziness score (1.0 vs 4.0; p<0.05), blurred vision score (0 vs 4.0; p<0.01), balance problems score (0 vs 4.0; p<0.05), sensitivity to light and confusion score (0 vs 4.0; p<0.01), orientation score (1. 0 vs 0; p<0.05) and immediate memory score (5.0 vs 4.0; p<0.05). Conclusions Key symptoms and signs predicted 30-day reattendance. The ED-CAT requires validation and refinement in a larger population to produce a short, practical, user-friendly, relevant tool for ED head injury assessment.
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Affiliation(s)
| | - Timothy H Rainer
- Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
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