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Context: Computer-based neurocognitive assessment programs commonly are used to assist in concussion diagnosis and management. These tests have been adopted readily by many clinicians based on existing test-retest reliability data provided by test developers.
Objective: To examine the test-retest reliability of 3 commercially available computer-based neurocognitive assessments using clinically relevant time frames.
Design: Repeated-measures design.
Setting: Research laboratory.
Patients or Other Participants: 118 healthy student volunteers.
Main Outcome Measure(s): The participants completed the ImPACT, Concussion Sentinel, and Headminder Concussion Resolution Index tests on 3 days: baseline, day 45, and day 50. Each participant also completed the Green Memory and Concentration Test to evaluate effort. Intraclass correlation coefficients were calculated for all output scores generated by each computer program as an estimate of test-retest reliability.
Results: The intraclass correlation coefficient estimates from baseline to day 45 assessments ranged from .15 to .39 on the ImPACT, .23 to .65 on the Concussion Sentinel, and .15 to .66 on the Concussion Resolution Index. The intraclass correlation coefficient estimates from the day 45 to day 50 assessments ranged from .39 to .61 on the ImPACT, .39 to .66 on the Concussion Sentinel, and .03 to .66 on the Concussion Resolution Index. All participants demonstrated high levels of effort on all days of testing, according to Memory and Concentration Test interpretive guidelines.
Conclusions: Three contemporary computer-based concussion assessment programs evidenced low to moderate test-retest reliability coefficients. Our findings do not appear to be due to suboptimal effort or other factors related to poor test performance, because persons identified by individual programs as having poor baseline data were excluded from the analyses. The neurocognitive evaluation should continue to be part of a multifaceted concussion assessment program, with priority given to those scores showing the highest reliability.
Key Words: intraclass correlation coefficient, effort, ImPACT, Concussion Sentinel, Concussion Resolution Index
Key Points
* Computer-based concussion evaluations did not provide stable measures of cognitive functioning in healthy adults.
* Inconsistent performance on concussion assessments may lead clinicians to inaccurate determinations of cognitive function.
* Clinicians should be cautious in interpreting findings of concussion assessments and should use a multifaceted approach.
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