Outcome measures used in adolescent sport-related concussion research: a scoping review

Abstract

Objectives: To provide an overview of the outcome measures currently used after sports-related concussion (SRC) in adolescents, categorising by the constructs they assess, follow-up duration and their feasibility of use.

Design: Scoping review.

Data sources: We searched three electronic databases (MEDLINE, EMBASE and CINAHL). We also undertook citation tracking of the included articles and searched for ongoing or unpublished trials using ClinicalTrials.gov and Theses Global.

Eligibility criteria: Studies tracking concussion recovery in adolescent athletes.

Results: 15 782 records were identified. After initial title and abstract screening, we retrieved 87 studies for full-text screening, with 75 studies fulfilling the eligibility criteria and included in the review, comprising 13 107 participants (9480 male, 3615 female and 12 unreported), ranging in age from 5 to 19 years. 46 different outcome measures were used, with Post-Concussion Symptom Scale (n=42) and Immediate Post-Concussion Assessment and Cognitive Testing (n=21) the most common. Most outcome measures quantified aspects of sensorimotor function including balance, oculomotor function and cognition. Follow-up duration ranged from 7 days to 1 year. 60% of studies ceased follow-up assessments within 6 weeks post-SRC.

Conclusions: Adolescent SRC literature uses a wide range of outcome measures. Most research quantifies cognitive/fatigue domains in the acute/subacute stages post-SRC, using male participants. Other key domains such as anxiety/mood, migraine and key modifiers (cervical and sleep disturbance) are less well represented in the literature. Many of the outcome measures used in current research are associated with high cost and require highly qualified examiners, creating barriers to their implementation in some adolescent sporting environments.

Study registration: https://doi.org/10.17605/OSF.IO/N937E.

Keywords: Adolescent; Paediatric neurology; Prognosis; SPORTS MEDICINE.

Figure 1. Eligibility flow chart.

Figure 2. Bar chart of the most common outcome measures in adolescent concussion research. ImPACT, Immediate Post-Concussion Assessment and Cognitive Testing; mBESS, modified Balance Error Scoring System; PCSS/R, Post-Concussion Symptom Scale.

Figure 3. Venn diagram which constructs and modifiers align with the outcome measures. ANAM, Automated Neurophysiological Assessment Metrics; AS, Anxiety Score; BCTT, Buffalo Concussion Treadmill Test; GAD7, Generalised Anxiety Disorder-7; ImPACT, Immediate Post-Concussion Assessment and Cognitive Testing; mBESS, modified Balance Error Scoring System; PANESS, Physical and Neurological Examination for Soft Signs; PCSS/R, Post-Concussion Symptom Scale; PHQ9, Patient Health Questionnaire 9; PROMIS 25, Patient-Reported Outcomes Measurement Information System; SCAT, Standard Concussion Assessment Tool.

Figure 4. Line graph of the study duration over time.