Abstract:
Objective: Computerised programmes are widely used to monitor recovery and facilitate safe return-to-play decisions. Typically, neurocognitive profiles of concussed athletes are compared with baseline and/or normative data in the absence of baseline scores. However, the cultural equivalence of performance on neuropsychological tests cannot be assumed. The purpose of this study, therefore, was to investigate the neuropsychological test profiles on the ImPACT test (designed for use in the concussion management arena), on South African (SA) versus US athletes. Design: A cross-sectional between-groups comparison of neuropsychological test scores. Setting: Multiple South African and US schools and sports organisations involved in concussion management programmes using ImPACT. Participants: Participants included 11 257 English-speaking, predominantly white male athletes in three age groups: 11–13 years (SA n = 301; US n = 775); 14–16 years (SA n = 997; US n = 4081); 17–21 years (SA n = 319; US n = 4784). Outcome Measures: ImPACT neurocognitive composite scores (verbal and verbal memory, visual motor speed, reaction time, impulse control) and the total ImPACT symptom score, derived from the initial baseline testing and used retrospectively for comparison purposes between the targeted groups. Results: Independent t test comparisons revealed an overall pattern of equivalence between the SA and US athletes on the neurocognitive measures, but a consistently higher symptom score for SA athletes in association with clinically relevant effect sizes. Conclusions: US neurocognitive normative data on the ImPACT test are appropriate for use on English first language SA athletes, whereas there appears to be culture-specific sensitivity for symptom reporting that needs to be taken into consideration for management purposes. The possibility of higher symptom reporting among SA athletes due to a higher incidence of concussion in rugby compared with football warrants further investigation via comparisons with equivalent non-contact sport controls.