Can the Buffalo Concussion Treadmill Test Be Used as a Prognostic Indicator for Patients With Sport-Related Mild Traumatic Brain Injury?

Abstract

Objective: To establish whether time to exercise cessation using the Buffalo Concussion Treadmill Test (BCTT) protocol can be used as a prognostic indicator of recovery after sport-related mild traumatic brain injury (SR-mTBI). Design: Retrospective analysis of prospectively collected data. Setting: Specialist Concussion Clinic. Participants: Three hundred and twenty one patients presenting between 2017 and 2019 who underwent BCTT for SR-mTBI. Interventions: Participants who remained symptomatic at a 2-week follow-up appointment after SR-mTBI underwent BCTT to develop a progressive subsymptom threshold exercise program with fortnightly follow-up until clinical recovery. Main Outcome Measures: Clinical recovery was the primary outcome measure. Results: A total of 321 participants were eligible to participate in this study (mean age 22.94% and 46% female). The BCTT test duration was divided into 4-minute intervals and those who completed full 20 minutes. There was higher probability of clinical recovery in those who finished the entire 20-minute BCTT protocol compared with those who managed 17–<20 minutes (Hazard Ratio, HR 0.57), 13 to 16 minutes (HR 0.53), 9 to 12 minutes (HR 0.6), 5 to 8 minutes (HR 0.4), and 1 to 4 minutes (HR 0.7), respectively. Those seen earlier after injury (P = 0.009), male patients (P = 0.116), younger patients (P = 0.0003), and those with physiological or cervical dominant (P = 0.416) symptom clusters were more likely to achieve clinical recovery. Fifty percent of those who completed the full BCTT protocol achieved clinical recovery at day 19 post‐injury. Conclusions: The group completing full 20 minutes of BCTT achieved clinical recovery more quickly than those who did not complete full BCTT.