Clinical application of the Buffalo Concussion Treadmill Test and the Buffalo Concussion Bike Test: A systematic review

Abstract

Objective To identify and synthesise research evidence regarding psychometric properties and clinical utility of the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Bike Test (BCBT) for use with patients with acute concussion, post-concussion syndrome (PCS) or physiological post-concussion disorder (PPCD). Data sources ProQuest (ProQuest Central), PEDro, Medline (Ovid), Emcare (Ovid), EBSCOhost (Health collection) and Google Scholar, searched September 8th-12th, 2020. Study selection Two authors independently selected studies that met eligibility criteria. Studies were selected if they were original research of any design, that investigated the properties of the testing protocols in either concussed or uninjured participants. Articles not published in English, that were not original research or that used significantly different testing protocols were excluded. The search yielded 250 articles, 11 of which were eligible and included in this review. Data extraction Included studies were critically appraised independently by two authors, using the Mixed Methods Appraisal Tool (MMAT). Data relating to study characteristics and key findings were extracted from the studies, documented in tables, and used to inform a critical narrative synthesis of findings. Data synthesis To provide recommendations relating to each aim of the review, a strength of evidence scoring system was used. Available evidence supported use of the BCTT, with strong evidence supporting the safety and construct validity of the test and moderate evidence supporting its prognostic value. There has been very limited research investigating use of the BCBT. Conclusion The findings support a recommendation for use of the BCTT in clinical settings for management of acute concussion, PCS and PPCD. There is limited evidence available for the BCBT. Additional studies are needed of both tests to further establish their clinical value.

The role of the physiotherapist in concussion

“…A common yet debilitating symptom of acute and persistent concussion is exercise intolerance. These patients are unable to exercise to their age-expected maximal heart rate without symptom exacerbation (Janssen, Pope & Rando 2022 ). This mechanism describes a neuro-autonomic cardiovascular dysfunction whereby the ANS causes altered signals to go to the heart.…”

“…This mechanism describes a neuro-autonomic cardiovascular dysfunction whereby the ANS causes altered signals to go to the heart. Graded exertional testing, such as the Buffalo Concussion Treadmill Test (BCTT) (Haider et al 2019 ; Janssen et al 2022 ; Mucha et al 2019 ) has emerged as a way of studying the connection between the ANS and concussion through measuring blood pressure responses and heart rate (Esterov & Greenwald 2017 ; Leddy et al 2007 ). Heart rate variability (HRV) disturbances post-concussion in athletes have been found to persist beyond symptom resolution and return to play protocols as well.…”

Concussion Rehabilitation

“…The most popular and validated test is the Buffalo Concussion test. It is done on atreadmill(BCTT) [45]withaprogressiveincrease of aerobic loading, measuring heart rate and symptom exacerbation. In particular, the patient is asked to wear a heart rate monitor and to step on a treadmill.…”