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Context: Currently, there is no gold standard to evaluate the effect of varying game-like exertion states on Sport Concussion Assessment Tool 3rd Edition (SCAT-3) outcomes. Baseline assessments may occur before, during, or after physical activity, while postinjury evaluations predominantly occur following physical activity. Thus, clinicians may be comparing postinjury evaluations completed following exertion to baseline evaluations completed following varying levels of rest or exertion, which may not be a valid method for clinical decision making. Objective: To determine the effect of various physical exertion levels on sideline concussion assessment outcomes and reliability. Design: Within-subjects, repeated measures. Setting: Field. Participants: Physically active participants (N = 36) who regularly participate in basketball activity. Intervention: Subjects participated in 2 simulated basketball games, completing a symptom checklist, Standardized Assessment of Concussion, and Balance Error Scoring System before game play, during halftime, and at the completion of each simulated game. Pulse rate was assessed as a proxy of physical exertion. Main Outcome Measures: Total symptom, Standardized Assessment of Concussion, and Balance Error Scoring System scores. Results: Physical exertion did not significantly predict symptom, Standardized Assessment of Concussion, or Balance Error Scoring System scores, although a trend toward higher symptom scores was observed for females (ß = 0.03, P = .09). All assessments had poor to moderate reliability across sessions (.15 < interclass correlation coefficient [2,1] < .60). Conclusion: Low- to moderate-intensity physical activity did not have a significant effect on clinical concussion sideline assessments; however, the low test–retest reliability observed prevents strong conclusions on these relationships. The poor overall reliability does not allow for clear recommendations for what state of baseline physical exertion (ie, rested or exerted) provides optimal data to make postinjury clinical decisions, although baseline concussion assessments completed at rest have the most valid and conservative normative values for injury comparison.
Dubas is with the Athletic Department, Villanova University, Villanova, PA, USA. Teel is with the School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada. Kay is with the School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA. Ryan, Petschauer, and Register-Mihalik are with the Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Register-Mihalik is also with the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.