The psychometric properties of concussion assessment tools in high school athletics
Hunt, Tamerah Nicole
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Recent leaders in concussion assessment have suggested the use of baseline test scores to measure premorbid function and allow athletes to serve as their own control. There are, however, several factors that may affect the psychometric properties of baseline scores. The factors investigated in this study were effort and reliability of the revised Balance Error Scoring System protocol. This research is two fold. First we examined the level of effort in an athletic population and determined if sub-optimal effort effects neuropsychological test scores. One hundred and ninety-nine high school athletes were administered a brief neuropsychological test battery including the Dot Counting Test (DCT) and the Rey 15-item test with recognition trial (R15-R). We found that Sub-optimal effort existed in an athletic population. Moreover, significant differences existed between effort groups on several of the neuropsychological tests. The presence of sub-optimal effort utilizing a gross measure of effort suggests a conservative estimate of sub-optimal effort. The addition of objective measures of effort will identify suboptimal effort and thus providing validity evidence of interpretations regarding baseline neuropsychological test scores. Second we calculated the reliability of the revised BESS protocol. One hundred and fortyfour high school athletes performed the revised protocol which consisted of three trials of four conditions (firm and foam surfaces and single leg and tandem stance). Statistically significant differences existed between trial one and trial two (F (1.65, 286) = 4.890, p=.013). Further, an intraclass reliability coefficient was obtained for three trials of four conditions (R = 0.88), two trials of four conditions (R = 0.84) and one trial of four conditions (R = 0.73). The revised protocol increased the reliability of the BESS scores however the presence of a practice effect suggests allowing additional familiarization trials prior to administration. Validating interpretations of test scores can not be accomplished without a reliable measure. Further, a thorough knowledge of the effect of confounding variables will clarify interpretations from test scores. Psychometrically sound instruments support the ability to make and interpret clinical decisions regarding injury and return to participation. Continual evaluation of the psychometric properties of commonly used concussion assessment tools will enable validation of interpretations from test scores.