Lynall Robert C, Schmidt Julianne D, Mihalik Jason P, Guskiewicz Kevin M
*Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina, Chapel Hill, North Carolina; †Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina; and ‡Department of Kinesiology, University of Georgia, Athens, Georgia.
Clin J Sport Med. 2016 Jul;26(4):285-90. doi: 10.1097/JSM.0000000000000260.
To evaluate the clinical utility of "rebaseline" testing (ie, new baseline) before the season after an athlete's concussion recovery by (1) determining differences between baseline and rebaseline scores, and (2) comparing differences to clinical reliable change indices (RCIs).
Retrospective cohort.
Clinical research center.
Thirty-four Division I collegiate athletes (16 females, 18 males; baseline age = 18.38 ± 0.78 years).
Neurocognitive, balance, and symptom testing was conducted at 3 times: (1) original baseline, (2) final postinjury before return-to-play, and (3) rebaseline completed before the next competitive season. Physicians diagnosed concussions, and all concussed athletes' returned-to-play during the same season.
Dependent variables included all neurocognitive domains, balance composite, and total symptom scores. Mean differences between sessions were compared with 80% RCIs to clinically interpret statistical findings.
Statistically significant improvements in neurocognitive performance were observed between baseline and rebaseline sessions: psychomotor speed (F1,33 = 13.79, P = 0.001), cognitive flexibility (F1,33 = 7.99, P = 0.008), processing speed (F1,32 = 15.93, P < 0.001), executive functioning (F1,33 = 9.61, P = 0.004), and reasoning (F1,32 = 7.63, P = 0.009). We observed significant improvement in balance (F1,29 = 22.26, P < 0.001), but no difference in total symptom score (P = 0.719). Participants performed statistically better at last postinjury compared with rebaseline in visual memory (F1,29 = 5.64, P = 0.024) and complex attention (F1,31 = 11.38, P = 0.002), but worse in processing speed (F1,30 = 8.92, P = 0.006). Participants reported more symptoms (F1.28 = 10.83, P = 0.003) at rebaseline than last postinjury. No observed mean differences exceeded RCIs.
All between-session improvements were within RCIs and therefore within expected test-retest variation. Our results suggest limited clinical utility for rebaseline assessments in the collegiate setting.
Despite statistically significant differences between test sessions, no differences exceeded RCIs, suggesting the differences were of little clinical utility in the interpretation of neurocognitive, balance, and symptom scoring.
通过（1）确定基线分数与重新基线分数之间的差异，以及（2）将这些差异与临床可靠变化指数（RCI）进行比较，评估运动员脑震荡恢复后赛季前“重新基线”测试（即新基线）的临床效用。
回顾性队列研究。
临床研究中心。
34名一级大学运动员（16名女性，18名男性；基线年龄 = 18.38 ± 0.78岁）。
在三个时间点进行神经认知、平衡和症状测试：（1）原始基线，（2）伤后最终恢复比赛前，（3）在下一个竞技赛季前完成的重新基线测试。医生诊断脑震荡，所有脑震荡运动员在同一赛季恢复比赛。
因变量包括所有神经认知领域、平衡综合指标和总症状评分。将各测试阶段之间的平均差异与80%的RCI进行比较，以从临床角度解释统计结果。
在基线和重新基线测试阶段之间观察到神经认知表现有统计学意义的改善：心理运动速度（F1,33 = 13.79，P = 0.001）、认知灵活性（F1,33 = 7.99，P = 0.008）、处理速度（F1,32 = 15.93，P < 0.001）、执行功能（F1,33 = 9.61，P = 0.004）和推理（F1,32 = 7.63，P = 0.009）。我们观察到平衡有显著改善（F1,29 = 22.26，P < 0.001），但总症状评分无差异（P = 0.719）。与重新基线相比，参与者在伤后最后阶段的视觉记忆（F1,29 = 5.64，P = 0.024）和复杂注意力（F1,31 = 11.38，P = 0.002）方面表现更好，但在处理速度方面更差（F1,30 = 8.92，P = 0.006）。参与者报告在重新基线时的症状（F1.28 = 10.83，P = 0.003）比伤后最后阶段更多。未观察到的平均差异超过RCI。
所有测试阶段之间的改善均在RCI范围内，因此在预期的重测变异范围内。我们的结果表明在大学环境中重新基线评估的临床效用有限。
尽管测试阶段之间存在统计学意义的差异，但没有差异超过RCI，这表明这些差异在神经认知、平衡和症状评分的解释中临床效用不大。
