903 MEP043 – Using the functional test for concussion as a final medical clearance check: can we prevent athletes from returning to sport prematurely?

AbstractBackground Exertional tests have become informative in assisting with concussion management and are commonly used for medical clearance (MC) decisions, however, the majority are resource intensive and require expertise. We developed an economical and easy to implement four-stage Functional Test for Concussion (FTC) using physical movement tasks that incorporate cardiovascular responses, head acceleration, coordination, and multi-tasks.Objective To evaluate whether FTC performance aligns with MC to return-to-play.Hypothesis Time to successful completion of the FTC will align or exceed time to achieve clinical MC.Design Prospective, observational cohort study.Setting Sport medicine clinic and research institution (University of Toronto, Canada).Participants Twenty-four interuniversity athletes with a physician diagnosed sport-related concussion (females=15, males=9) and thirty healthy interuniversity athletes (females=14, males=16).Interventions A four-stage Functional Test for Concussion at 1-, 2-, 3-, 4-, 6-, and 8-weeks post-concussion and at baseline for healthy athletes. Independent variables: 1) binary indicator for the group membership (concussion vs. healthy), and 2) binary indicator of pass/fail for each stage of the FTC. Main Outcome Measurements FTC parameters including change in symptoms following each FTC task compared to initial score, performance metrics (time duration and errors), and heart rate.Results 50%, 33.3%, 14.3%, and 11.1% of athletes failed the FTC at 1-, 2-, 3-, and 4-weeks post-concussion, respectively. Two athletes failed the FTC on the week they were scheduled for MC while thirteen athletes passed. During weeks 1–4, athletes with concussion exhibited greater symptom change during the FTC compared to normative data. By week 6, all athletes with concussion successfully completed the FTC. During all weeks, heart rates aligned between athletes with concussion who successfully completed the FTC and normative data. Conclusions The FTC may be able to elicit ongoing functional deficits beyond clinical recovery. Additional research is underway to determine if the FTC can offer clinical utility.