Repeat Administration Elicits a Practice Effect With the Balance Error Scoring System but Not With the Standardized Assessment of Concussion in High School Athletes

Abstract

OBJECTIVE: To assess whether repeated administration of the Standardized Assessment of Concussion (SAC) and Balance Error Scoring System (BESS) demonstrates a practice effect in high school athletes. DESIGN AND SETTING: Subjects were assigned to either a control or practice group. Subjects in the control group were assessed twice, 30 days apart. Subjects in the practice group were assessed on 5 occasions. Four assessments were performed within a 7-day period and 1 more assessment 30 days after the initial test. SUBJECTS: Thirty-two uninjured high school athletes participated in this investigation. Sixteen were randomly assigned to a control group and 16 to a practice group. MEASUREMENTS: We measured performance on the SAC and on 6 test conditions of the BESS. RESULTS: We found a significant time-by-group interaction on BESS performance on the day-30 test session. A significant practice effect of the BESS was found during the course of repeated administrations in the practice group. After repeated testing, the number of BESS errors decreased with each test session, and error scores on day 5 (10.94 +/- 2.17) and day 7 (9.44 +/- 3.32) were significantly lower than the baseline score (12.88 +/- 3.34). We did not find group differences or a practice effect on the SAC (baseline score = 26.16). CONCLUSIONS: Our results revealed no practice effect with the SAC and a slight practice effect with repeated administrations of the BESS, especially with the single-leg stance on foam. Clinicians must acknowledge the potential for practice effects when readministering these concussion assessments to track recovery of an athlete or as a guide in return-to-play decision making.

Figure 1

Standard Assessment of Concussion scores for each domain across the repeated testing days in the practice group. *Orientation scores significantly less than baseline. †Delayed-recall scores significantly less than baseline.

Figure 2

Total Balance Error Scoring System score between groups on the baseline and day-30 tests. *Significantly different between groups on day 30.

Figure 3

Total Balance Error Scoring System scores across the repeated testing days in the practice group. *Significantly less than baseline.

Figure 4

Time-by-surface interaction across the repeated test sessions in the practice group. *Significantly different from baseline.

Figure 5

Time-by-stance interaction across the 5 test sessions in the practice group. *Single-leg day-7 score significantly less than baseline.