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- Title
Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review.
- Authors
Dunne, Laura A. M.; Cole, Michael H.; Cormack, Stuart J.; Howell, David R.; Johnston, Rich D.
- Abstract
Background: There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. Objectives: This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. Methods: A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. Results: A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. Conclusion: These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. Trail Registration: This systematic review was registered on PROSPERO (reg no. CRD42021256298).Key Points: Commonly used subjective static assessments such as the Balance Error Scoring System (BESS) displayed insufficient test–retest reliability and construct validity for the detection of sports-related concussion (SRC). Instrumented static balance assessments using laboratory equipment (i.e. force plate) or portable microtechnology (i.e. inertial measurement units) demonstrated better test–retest reliability and construct validity compared to subjective assessments. However, all static balance assessments displayed a poor ability to detect persistent symptoms of SRC beyond acute stages (> 2 weeks post). Instrumented dynamic assessments demonstrated sufficient test–retest reliability. The instrumented Y-balance test demonstrated sufficient sensitivity in adult populations, but poor specificity. Instrumented and non-instrumented gait assessments displayed sufficient test–retest reliability and construct validity. The addition of a cognitive task (dual-task) improved sensitivity. Laboratory assessments display sufficient reliability and validity, but poor ecological validity for the assessment of field-based sports due to the controlled environmental conditions. Associated costs, equipment, and personnel also limit the utility of these assessments for team-sport athletes. Clinicians are encouraged to implement instrumented or non-instrumented dynamic balance or gait assessments based on the individual needs and abilities within their setting. If practitioners do not have the resources to perform instrumented tests, it is recommended that they consider the reliability and validity issues that potentially limit the simpler test options, with gait assessments recommended over static or dynamic
- Publication
Sports Medicine - Open, 2023, Vol 9, Issue 1, p1
- ISSN
2199-1170
- Publication type
Article
- DOI
10.1186/s40798-023-00625-0