P124: A new in-skates balance error scoring system for the sideline assessment of concussion in hockey players

Abstract

Introduction: During a hockey game, athletes who are suspected of having sustained a concussion are removed from the game and evaluated. The modified balance error scoring system (MBESS) assessment, an essential part of the concussion evaluation, is performed in the dressing room, barefoot on a hard surface after equipment removal. While, players that pass the concussion assessment may re-dress and return to play, the equipment removal and re-dressing delays their return into the game. The objective of our study was to develop and evaluate a new in-skates balance error scoring system (SBESS) to reduce the delay in returning to the game. Methods: A prospective randomized single blinded study was conducted with 80 healthy university hockey players split into two groups. An at-rest group performed the SBESS assessment at rest on two separate occasions. A post-exercise group performed the test once at rest and once after exercise. The SBESS consisted of performing 4 different stances for 20 seconds each without equipment removal. The assessments were video recorded, and 3 independent reviewers scored the videos. For both the at-rest and post-exercise groups, the primary outcome measured was the number of balance errors. The secondary outcome was the number of falls. Statistics: For the primary outcome, both inter-rater and intra-rater reliability were calculated. The concordance between the SBESS and the currently used baseline pre-season balance score (MBESS) was also assessed. Results: The number of cumulative balance errors for all four stances varied between 4 and 7 for both groups without any significant exercise effect. No athletes fell. For inter-rater reliability, the intra-class correlation (ICC) was above 0.86, ranging from 0.86-0.92 for most stances except for the easiest stance, for which it was 0.66. For intra-rater reliability, the ICC ranged from 0.88 to 1 for all stances and raters. There was a lack of concordance between the SBESS and MBESS. Conclusion: The SBESS is a reliable balance test that can be safely performed in healthy athletes wearing their full equipment. The next step will be to evaluate the use of this test on concussed hockey athletes