Valid but Invalid: Suboptimal ImPACT© Baseline Performance in University Athletes

ABSTRACTPurposeTo investigate the frequency of valid yet suboptimal Immediate Postconcussion Assessment and Cognitive Test© (ImPACT) performance in university athletes and to explore the benefit of subsequent ImPACT administrations.MethodsThis descriptive laboratory study involved baseline administration of ImPACT to 769 university athletes per the institution's concussion management protocol. Testing was proctored in groups of ≤ 2 participants. Participants who scored below the 16th percentile according to ImPACT normative data were re-administered ImPACT up to two additional times as these scores were thought to be potentially indicative of suboptimal effort or poor understanding of instructions. Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed and Reaction Time ImPACT composite scores in initial and subsequent administrations.ResultsBased on ImPACT's validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite score 16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to "valid" but invalid baseline performance. Purpose To investigate the frequency of valid yet suboptimal Immediate Postconcussion Assessment and Cognitive Test© (ImPACT) performance in university athletes and to explore the benefit of subsequent ImPACT administrations. Methods This descriptive laboratory study involved baseline administration of ImPACT to 769 university athletes per the institution's concussion management protocol. Testing was proctored in groups of ≤ 2 participants. Participants who scored below the 16th percentile according to ImPACT normative data were re-administered ImPACT up to two additional times as these scores were thought to be potentially indicative of suboptimal effort or poor understanding of instructions. Descriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed and Reaction Time ImPACT composite scores in initial and subsequent administrations. Results Based on ImPACT's validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite score 16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to "valid" but invalid baseline performance. Corresponding Author: Samuel R. Walton, 210 Emmet St. S, Department of Kinesiology, University of Virginia, Charlottesville, VA, United States, 22904. Telephone: 1-207-991-0659, Fax: 1-434-982-1389, srw2rf@virginia.edu No authors received funding for this study. The authors have no conflicts of interest to report. The results of the current study do not constitute endorsement by ACSM. The authors declare that the results of this study are clear and honest, were not fabricated or falsified and that the data were not manipulated in any way to intentionally portray anything but those outcomes which were empirically observed. Accepted for Publication: 20 February 2018 © 2018 American College of Sports Medicine

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