Objective turning measures improve diagnostic accuracy and relate to real-world mobility/combat readiness in chronic mild traumatic brain injury

Abstract

Introduction Balance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and non-straight locomotion, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess 1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and 2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically-relevant functional tasks. Materials and Methods Fifty-three individuals with mTBI and 57 healthy controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically-relevant functional tasks. Results Multivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple clinic-based turning variables. The complex turning course (CTC) yielded the highest multivariate AUC (95% CI) of 0.90 (0.84, 0.95) for single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically-relevant functional tasks and outperformed general assessments of mobility. Discussion Clinic-based turning tasks, especially the CTC, have high diagnostic accuracy, strong associations with ecologically-relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically-relevant to daily function. Future work should continue to examine the CTC alongside other promising tools for return-to-activity assessments.