Test-Retest, Interrater Reliability, and Minimal Detectable Change of the Dynamic Exertion Test (EXiT) for Concussion. (May 2023)

• Record Type: Journal Article
• Authors: Sinnott, Aaron M.; Eagle, Shawn R.; Kochick, Victoria; Bricker, Indira R.; Collins, Michael W.; Sparto, Patrick J.; Flanagan, Shawn D.; Elbin, R. J.; Connaboy, Christopher; Kontos, Anthony P.
• Is Part Of: Sports health. Volume 15:Number 3(2023)
• Page Start: 410
• Page End: 421
• Publication Date: 2023-05
• Subjects: concussion -- exertion -- injury -- medical clearance -- mild traumatic brain injury; Sports medicine -- Periodicals; Athletic Injuries -- Periodicals; Physical Education and Training -- Periodicals; Musculoskeletal Physiological Phenomena -- Periodicals; Médecine du sport -- Périodiques; 617.1027
• DOI: 10.1177/19417381221093556
• Languages: English
• ISSNs: 1941-7381

Abstract

Background: The Dynamic Exertion Test (EXiT) was developed to inform return-to-play (RTP) decision-making following clinical recovery from sport-related concussion (SRC). The purpose of the current study was to document intrarater and test-retest reliability and minimal detectable change (MDC) scores for physiological [heart rate (HR) and blood pressure], performance (change-of-direction task completion time and errors), and clinical outcomes (endorsed symptoms, perceived exertion) of EXiT, and interrater reliability of performance outcomes. Hypothesis: Healthy athletes would exhibit stable physiological responses to the EXiT across visits, demonstrate consistent change-of-direction task completion time between consecutive trials at each visit, and the fastest time (of 2 trials) across visits, and endorse equivocal symptoms and effort across visits. Study Design: Cross-sectional, test-retest. Level of Evidence: Level 3. Methods: Seventy-nine (female: 34 [43%], 19.6 ± 5.0 years) athletes completed the EXiT at 2 study visits (8.7 ± 4.7 days between visits). Two-way, mixed, intraclass correlation coefficients (ICCs) were used to evaluate intrarater and test-retest reliability. Cronbach's alpha was used to document the internal consistency of symptoms at each visit, and MDC scores were calculated on the physiological, performance, and clinical outcomes. Results: Measured and percentage of age-estimated maximum HR were reliable following EXiT (ICC = 0.579-0.618). Change-of-direction task completion time (MDC range = 0.75-8.70 s) had good-to-excellent test-retest (ICC = 0.703-0.948) and interrater (ICC = 0.932-0.965) reliability. Symptoms had a high internal consistency at visits 1 ( α = 0.894) and 2 ( α = 0.805) and were reliable across visits (ICC = 0.588). Conclusion: The current investigation established test-retest reliability in addition to MDC scores of an objective dynamic exercise assessment among healthy adolescent and adult athletes. The EXiT may be an objective approach to inform RTP decision-making following SRC recovery. Clinical Relevance: The EXiT is a clinically feasible exertion-based assessment that can be readily administered in a variety of outpatient clinical settings.