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Scratch S, Shore J, DuPlessis D, Lovell A, Hickling A, Gill P, Mallory K, Lam E, Hotze F, Zemek R, Emery C, Schneider K, Hutchison M, Gagnon I, Caron J, Reed N, Biddiss E. Return-to-Play With R2Play: Protocol for Evaluating Cross-Site Feasibility, Face Validity, and Content Validity of a Multidomain Concussion Assessment Tool for Youth. J Sport Rehabil 2025; 34:210-224. [PMID: 39515307 DOI: 10.1123/jsr.2024-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/17/2024] [Accepted: 07/23/2024] [Indexed: 11/16/2024]
Abstract
CONTEXT Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport. OBJECTIVES To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data. METHODS Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10-25 y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity. DISCUSSION This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.
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Affiliation(s)
- Shannon Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Josh Shore
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Danielle DuPlessis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Andrew Lovell
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Pavreet Gill
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Kylie Mallory
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Emily Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Fanny Hotze
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Caron
- School of Kinesiology and Exercise Science, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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