Test-Retest Reliability of Concussion Baseline Assessments in United States Service Academy Cadets: A Report from the National Collegiate Athletic Association (NCAA)-Department of Defense (DoD) CARE Consortium

Megan N. Houston*, Kathryn L. Van Pelt, Christopher D'Lauro, Rachel M. Brodeur, Darren E. Campbell, Gerald T. McGinty, Jonathan C. Jackson, Tim F. Kelly, Karen Y. Peck, Steven J. Svoboda, Thomas W. McAllister, Michael A. McCrea, Steven P. Broglio, Kenneth L. Cameron

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objective: In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test-retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies. Methods: All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals. Results: ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44. Conclusions: This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-To-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.

Original languageEnglish
Pages (from-to)23-34
Number of pages12
JournalJournal of the International Neuropsychological Society
Volume27
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • Balance
  • Change score
  • Mild traumatic brain injury
  • Neurocognitive
  • Neuropsychological tests
  • Symptoms

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