Abstract:
Context: Computerized neurocognitive tests (CNTs) are widely used at all competitive levels of sport to assess sport-related concussion (SRC). Despite the adoption of CNTs into a majority of SRC management protocols, a dearth of psychometric evidence exists to support their clinical utility. Recent studies suggest CNTs possess sub-optimal reliability which inherently limits validity and clinical utility. Objective: To investigate the test-retest reliability of Automated Neuropsychological Assessment Metrics (ANAM), Concussion Vital Signs (CVS) and the Immediate Postconcussion and Cognitive Testing battery (ImPACT) using empirically derived time points. Design: Repeated measures. Setting: Research laboratory. Patients or Other Participants: One hundred and twenty-nine healthy participants (30 males, 99 females): mean age 19.4 + 1.70 years with no history of concussion within six months of participation, a diagnosed psychiatric condition, learning disability, and/or ADD/ADHD. Intervention(s): Participants were randomly assigned into one of three groups which were administered ANAM (n = 42), CVS (n = 46) or ImPACT (n = 41) at Days 1, 45, and 50. Green’s Word Memory Test (WMT) was also administered pre and postcompletion of each CNT to assess effort for at each time point. Main Outcome Measure(s): Reliability was calculated using intraclass correlation coefficients (ICCs) utilizing a one-way random model between time points for each CNT’s summary scores. Repeated measures ANOVAs were used to determine significant differences in CNT and WMT performance across time. Greenhouse Geisser corrections were utilized to correct for violations of sphericity. Paired t-tests were used for post-hoc analyses. Analyses were performed with α = .05. Results: Participants were tested approximately 47.0 + 2.75 days after time point 1 and approximately 7.0 + 2.40 days after time point 2. Groups differences ICC values ranged from .11 (Mathematical Processing) to .70 (Simple Reaction Time) for ANAM, -.02 (Continuous Performance Test) to.87 (Psychomotor Speed) for CVS, and .32 (Verbal Memory) to .94 (Visual Motor Speed) for ImPACT. Results of the repeated measures ANOVA revealed one significant improvement over time for ImPACT’s Visual Motor Speed (F (1.739, 69.574) = 3.34, p = .048) summary score between time points 1 and 3 (t(40) = -2.19, p = .034). WMT scores exceeded 85 percent for all participants suggesting a good effort was provided at each time point. Conclusions: This is one of the first studies addressing the reliability of three commonly used CNTs administered in a healthy college aged sample. Overall, weak to strong reliability coefficients for ANAM, CVS, and ImPACT were observed. Results suggest that regardless of the CNT used to manage SRC, caution is necessary when interpreting repeated CNT scores over time and furthermore support the use of a multidisciplinary approach to SRC management.