Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-28T11:06:51.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Multivariate Base Rates of Low Scores and Reliable Decline on ImPACT in Healthy Collegiate Athletes Using CARE Consortium Norms

Published online by Cambridge University Press:  05 July 2019

Zac M. Houck ,
Breton M. Asken ,
Russell M. Bauer ,
Anthony P. Kontos ,
Michael A. McCrea ,
Thomas W. McAllister ,
Steven P. Broglio ,
James R. Clugston  and
Care Consortium Investigators
Zac M. Houck*
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA
Breton M. Asken
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
Russell M. Bauer
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA
Anthony P. Kontos
Affiliation:
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
Michael A. McCrea
Affiliation:
Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53266, USA
Thomas W. McAllister
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
Steven P. Broglio
Affiliation:
Department of Kinesiology, NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Michigan 48109, USA
James R. Clugston
Affiliation:
Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida 32610, USA
Care Consortium Investigators
Affiliation:
Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida 32610, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53266, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA Department of Kinesiology, NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Michigan 48109, USA Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida 32610, USA
*
Correspondence and reprint requests to: Zac M. Houck, Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

Keywords

Cognitive functioningBaseline testingCAREReliable changeRaceConcussion
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 9 , October 2019 , pp. 961 - 971
Copyright
Copyright © INS. Published by Cambridge University Press, 2019. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bailey, C.M., Samples, H.L., Broshek, D.K., Freeman, J.R., & Barth, J.T. (2010). The relationship between psychological distress and baseline sports-related concussion testing. Clinical Journal of Sport Medicine, 20(4), 272–277. doi: 10.1097/JSM.0b013e3181e8f8d8 CrossRefGoogle ScholarPubMed
Barr, W.B., & McCrea, M. (2001). Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. Journal of the International Neuropsychological Society, 7(6), 693–702.CrossRefGoogle ScholarPubMed
Binder, L.M., Iverson, G.L., & Brooks, B.L. (2009). To err is human:“Abnormal” neuropsychological scores and variability are common in healthy adults. Archives of Clinical Neuropsychology, 24(1), 31–46.CrossRefGoogle Scholar
Broglio, S.P., Katz, B.P., Zhao, S., McCrea, M., McAllister, T., & Investigators, C.C. (2018). Test–Retest Reliability and Interpretation of Common Concussion Assessment Tools: Findings from the NCAA-DoD CARE Consortium. Sports Medicine, 48(5), 1255–1268.CrossRefGoogle ScholarPubMed
Broglio, S.P., McCrea, M., McAllister, T., Harezlak, J., Katz, B., Hack, D., Hainline, B., & CARE Consortium Investigators. (2017). A National Study on the Effects of Concussion in Collegiate Athletes and US Military Service Academy Members: The NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium Structure and Methods. Sports Medicine, 47(7), 1437–1451.CrossRefGoogle Scholar
Brooks, B.L., Strauss, E., Sherman, E., Iverson, G.L., & Slick, D.J. (2009). Developments in neuropsychological assessment: Refining psychometric and clinical interpretive methods. Canadian Psychology/Psychologie Canadienne, 50(3), 196.CrossRefGoogle Scholar
Covassin, T., Elbin, R., Kontos, A., & Larson, E. (2010). Investigating baseline neurocognitive performance between male and female athletes with a history of multiple concussion. Journal of Neurology, Neurosurgery and Psychiatry, 81(6), 597–601. doi: 10.1136/jnnp.2009.193797 CrossRefGoogle ScholarPubMed
Covassin, T., Swanik, C.B., Sachs, M., Kendrick, Z., Schatz, P., Zillmer, E., & Kaminaris, C. (2006). Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. British Journal of Sports Medicine, 40(11), 923–927; discussion 927. doi: 10.1136/bjsm.2006.029496 CrossRefGoogle ScholarPubMed
Elbin, R.J., Kontos, A.P., Kegel, N., Johnson, E., Burkhart, S., & Schatz, P. (2013). Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: evidence for separate norms. Archives of Clinical Neuropsychology, 28(5), 476–484. doi: 10.1093/arclin/act024 CrossRefGoogle ScholarPubMed
Fritz, C.O., Morris, P.E., & Richler, J.J. (2012). Effect size estimates: Current use, calculations, and interpretation. Journal of Experimental Psychology: General, 141(1), 2.CrossRefGoogle ScholarPubMed
Heaton, R., Miller, S.W., Taylor, M.J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead–Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz, FL: Psychological Assessment Resources.Google Scholar
Hinton-Bayre, A.D., Geffen, G.M., Geffen, L.B., McFarland, K.A., & Frijs, P. (1999). Concussion in contact sports: Reliable change indices of impairment and recovery. Journal of Clinical and Experimental Neuropsychology, 21(1), 70–86.CrossRefGoogle ScholarPubMed
Houck, Z., Asken, B., Clugston, J., Perlstein, W., & Bauer, R. (2018). Socioeconomic status and race outperform concussion history and sport participation in predicting collegiate athlete baseline neurocognitive scores. Journal of the International Neuropsychological Society, 24(1), 1–10.CrossRefGoogle ScholarPubMed
Iverson, G.L., Lovell, M.R., & Collins, M.W. (2003). Interpreting change on ImPACT following sport concussion. The Clinical Neuropsychologist, 17(4), 460–467.CrossRefGoogle ScholarPubMed
Iverson, G.L., & Schatz, P. (2015). Advanced topics in neuropsychological assessment following sport-related concussion. Brain Injury, 29(2), 263–275.CrossRefGoogle ScholarPubMed
Katz, B.P., Kudela, M., Harezlak, J., McCrea, M., McAllister, T., Broglio, S.P., & Investigators, C.C. (2018). Baseline performance of NCAA athletes on a concussion assessment battery: A report from the CARE consortium. Sports Medicine, 48(8), 1–15.CrossRefGoogle ScholarPubMed
Kontos, A.P., Elbin, R.J., Covassin, T., & Larson, E. (2010). Exploring differences in computerized neurocognitive concussion testing between African American and White athletes. Archives of Clinical Neuropsychology, 25(8), acq068.CrossRefGoogle ScholarPubMed
Lovell, M., Collins, M., Podell, K., Powell, J., & Maroon, J. (2000). ImPACT: Immediate post-concussion assessment and cognitive testing. Pittsburgh, PA: NeuroHealth Systems, LLC.Google Scholar
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R.C., Cassidy, D., Echemendia, R.J., Castellani, R.J., & Davis, G.A. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838–847.Google Scholar
Mormile, M.E.E., Langdon, J.L., & Hunt, T.N. (2018). The role of gender in neuropsychological assessment in healthy adolescents. Journal of sport rehabilitation, 27(1), 16–21.CrossRefGoogle ScholarPubMed
Weber, M.L., Dean, J.-H.L., Hoffman, N.L., Broglio, S.P., McCrea, M., McAllister, T.W., Schmidt, J.D., CARE Consortium Investigators, Hoy, AR, Hazzard, J.B., & Kelly, L.A. (2018). Influences of mental illness, current psychological state, and concussion history on baseline concussion assessment performance. The American journal of sports medicine, 46(7), 1742–1751.CrossRefGoogle ScholarPubMed
Supplementary material: File

Houck et al. supplementary material

Houck et al. supplementary material
Download Houck et al. supplementary material(File)
File 13.9 KB