Utility of repeated assessment after invalid baseline neurocognitive test performance.
Schatz P, Kelley T, Ott SD, Solomon GS, Elbin RJ, Kiggins K, and Moser RS. J Athl Training. 2014. 49(5): 659-664.
Take Home Message: Among athletes with an invalid computerized neurocognitive test at baseline, 87% received valid scores upon reassessment, which suggests reassessment can be used to gain a valid baseline score.
A number of concussion evaluation tools can help clinicians make objective return to play decisions. Some athletes attempt to perform poorly on their baseline testing to allow them to return to activity more quickly; however, this may cause their test to be flagged as invalid. It is currently not understood if retesting athletes with an invalid score at baseline is beneficial or not in obtaining a valid baseline assessment. Therefore, Schatz and colleagues completed a study to determine the utility of readministering a baseline assessment using a computerized neurocognitive tool. The authors included athlete data that they extracted from regional databases. All athletes reported in English, had an invalid baseline measure using the online ImPACT test battery, and were reassessed within 2 weeks. The 156 athletes participated in a variety of sports, were predominantly male, and took the baseline assessment under the supervisions of the school or university’s medical staff. Of the 156 included athletes, 9 self-reported having attention-deficit disorder, 6 self-reported a learning disability, and 1 reported both attention-deficit disorder and a learning disability. Overall, 136 athletes (87%) who initially were identified as having an invalid baseline measurement, obtained a valid measure upon reassessment. The most common causes for invalid results at the initial and second test was Three Letter Memory subscale and Design Memory learning subscale. Forty percent of participants had slower reaction times during the second testing session. Of the 20 who did not have a valid score upon reassessment, 7 reported either attention-deficit disorder, a learning disability, or both.
The present study provides results which should be of interest to clinicians, especially those who use and administer computer-based neurocognitive tests. The results suggest that reassessing athletes who had invalid baseline scores may produce valid baseline scores, which is critical to the assessment, treatment, and return to participation of concussed athletes. Further, it should be noted that not all athletes had valid results upon reassessment, and of that cohort, 35% (7 of 20) reported having attention-deficit disorder, a learning disability, or both; although, this was self-reported and not confirmed. Clinicians should be cautious when administering and evaluating the results of these tests to have an understanding of the athlete’s medical history. Ultimately, to avoid purposeful poor performance, reassessment is shown to have value to clinicians. One point of caution however is that the current study did not attempt to identify why this reassessment affected the change in scores. Until more research can be done to better understand this relationship, this study shows value in re-testing those athletes who have invalid baseline scores.
Questions for Discussion: Do you encounter a large number of athletes who have invalid baseline scores on computer-based neurocognitive tests? If so, how do you address athletes who have an invalid score?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban