Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making

Abstract

The Concussion Resolution Index (CRI) is an online assessment tool designed to track resolution of symptoms following sports-related concussion. The CRI is composed of six subtests measuring reaction time, visual recognition, and speed of information processing. Three factors are derived from the subtests: Simple Reaction Time (SRT), Complex Reaction Time (CRT), and Processing Speed (PS). Multiple alternate forms within subtests afford simple, reliable, assessment of change, relative to a baseline test completed by an athlete. The test also assesses self-reported neurophysiological symptoms at the time of injury and tracks resolution of these symptoms. The data demonstrate the CRI is a valid and reliable measure of cognitive performance in a relatively heterogeneous group of athletes aged 13-35. Two methods of statistical analysis for assessing change from baseline were compared to establish a psychometric basis for return-to-play decision-making: the Reliable Change Index (RCI) and multiple regression. Multiple regression was more accurate than the RCI in determining a decline in performance relative to the baseline.

ImPact Test-Retest Reliability: Reliably Unreliable?

“…In addition, their findings were similar to ours when using a longer testretest time interval and the same test form. 8,9,21 We controlled for random error by testing individuals at approximately the same time of day; testing in the same environment; and following a standardized testing procedure, using the ImPACT manufacturer's instructions and controlling for effort. Although we accounted for sources of random error, systematic error may have influenced our results through hardware and software applications.…”

“…6 Randolph et al 6 reviewed the psychometric properties of computerized neuropsychological testing platforms and found limited to no evidence of reliability and validity for all existing computerized platforms. Several groups [6][7][8][9][10] investigating the reliability of the ImPACT (ImPACT Applications, Pittsburgh, PA) have found intraclass correlation coefficients (ICCs) ranging from 0.15 to 0.85 for any 1 outcome measure. Specifically, higher ICCs (0.38 to 0.85) were reported for the ImPACT composite visual motor speed and composite reaction time scores and lower ICCs (0.23 to 0.64) for composite visual and verbal memory.…”

Sport-Related Concussion in Children and Adolescents

“…[76][77][78][79][80][81][82][83][84] One critique of the computerized tests is that the vast majority of studies have been conducted by the developers of the tests, which raises some concern for bias, because some independent study results have suggested slightly less reliable results. 85,86 A few of these computerized tests have been widely adopted at all levels of sport participation.…”

Utility of a multimodal neurophysiologic assessment tool in distinguishing between individuals with and without a history of mild traumatic brain injury

“…The CSI also employs a traditional continuous performance test format in computerized form to measure attention, response speed, and multitasking (executive function) [12]. The CSI provides rapid and repeatable neurocognitive screenings with instantly accessible results.…”

“…Based on preliminary data, the modalities chosen were computerized formats of eyetracking, balance and stability, and neurocognitive assessments. While all three modalities have been individually validated as being able to distinguish between concussed and nonconcussed populations [10][11][12][13], the goal of this study was to examine the enhancement in individual test discriminatory capability through the combination of all three assessment modality scores into a single, integrated multimodal system score. A secondary goal of the research was to assess the feasibility of developing a field-deployable system, with the compressed assessment, score compilation time, and portability that this application requires.…”