Efficacy of Tandem Gait to Identify Impaired Postural Control following Concussion

AbstractPurposeThe purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely post-concussion in collegiate student-athletes. Additionally, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity.MethodsSeventy-six NCAA student-athletes performed TG and BESS tests: 38 acutely post-concussion and 38 controls. Participants were tested at baseline (Time 1) and again acutely post-concussion, or the following year for controls (Time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater MDC. A 2 x 2 mixed design ANOVA compared each outcome variable. An ROC curve analysis was utilized to evaluate sensitivity, specificity, and area under the curve (AUC).ResultThere was a significant interaction (F= 8.757, p= 0.004) for TG whereby the concussion group was slower post-concussion (10.59 ± 1.53 vs. 11.80 ± 2.67 seconds), while there was no difference for controls (10.13 ± 1.72 vs. 9.93 ± 1.85 seconds). There was no significant interaction for BESS (F= 0.235, p= 0.630) or mBESS (F= 0.007, p= 0.935). TG had a sensitivity of 0.632, specificity of 0.605, and AUC of 0.704. BESS had a sensitivity of 0.447, specificity of 0.500, and AUC of 0.508. mBESS had a sensitivity of 0.474, specificity of 0.632, and AUC of 0.535.ConclusionParticipants completed TG significantly slower following concussion, while no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting post-concussion postural control assessments. Purpose The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely post-concussion in collegiate student-athletes. Additionally, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. Methods Seventy-six NCAA student-athletes performed TG and BESS tests: 38 acutely post-concussion and 38 controls. Participants were tested at baseline (Time 1) and again acutely post-concussion, or the following year for controls (Time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater MDC. A 2 x 2 mixed design ANOVA compared each outcome variable. An ROC curve analysis was utilized to evaluate sensitivity, specificity, and area under the curve (AUC). Result There was a significant interaction (F= 8.757, p= 0.004) for TG whereby the concussion group was slower post-concussion (10.59 ± 1.53 vs. 11.80 ± 2.67 seconds), while there was no difference for controls (10.13 ± 1.72 vs. 9.93 ± 1.85 seconds). There was no significant interaction for BESS (F= 0.235, p= 0.630) or mBESS (F= 0.007, p= 0.935). TG had a sensitivity of 0.632, specificity of 0.605, and AUC of 0.704. BESS had a sensitivity of 0.447, specificity of 0.500, and AUC of 0.508. mBESS had a sensitivity of 0.474, specificity of 0.632, and AUC of 0.535. Conclusion Participants completed TG significantly slower following concussion, while no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting post-concussion postural control assessments. Corresponding Author: Thomas A. Buckley, Ed.D., ATC, Associate Professor, Human Performance Lab, University of Delaware, 541 South College Avenue, Newark, DE 19716, USA. Tbuckley@udel.edu This study is supported from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium Clinical Study Core, which is jointly funded by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DoD). There are no conflicts of interest associated with the authors of this study. The results of the present study do not constitute endorsement by ACSM and are presented without fabrication, falsification, or data manipulation. Accepted for Publication: 13 December 2017 © 2018 American College of Sports Medicine

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