Wingerson Mathew J, Seehusen Corrine N, Walker Gregory, Wilson Julie C, Howell David R
a Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.
b Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
J Athl Train. 2020 Nov 5;58(2):106-11. doi: 10.4085/323-20.
Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity.
To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion.
Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials.
We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups.
Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67).
Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.
与运动相关的脑震荡的临床管理需要评估包括运动表现在内的各种因素。串联步态测试是一种评估损伤后运动表现的方法，已证明具有临床实用性，但受时间可用性和测试一致性的限制。
评估串联步态测试各次试验之间的组内可靠性，并确定在脑震荡后的临床决策中实现最佳实用性和可行性所需的试验次数。
横断面研究
儿科运动医学诊所
近期发生脑震荡的青少年运动员（n = 44；年龄 = 15.4±1.8岁；39%为女性），在受伤后14天内（7.3±3.2天）前来就诊，以及未受伤的对照参与者（n = 73；年龄 = 15.8±1.3岁；41%为女性）。所有参与者均完成了三次单任务和三次双任务串联步态试验。
我们收集了每次试验的测试完成时间和认知表现，并计算试验之间的皮尔逊相关系数和组内相关系数以确定组内可靠性。我们还比较了各组之间的表现，并计算曲线下面积（AUC）值以确定每次试验区分各组的能力。
脑震荡组和对照组在单任务（R≥0.82；ICC≥0.93）和双任务条件下（R≥0.79；ICC≥0.92）的串联步态试验之间均表现出较高的组内可靠性。最大的组分类值来自第二次单任务试验（AUC = 0.89）和第一次双任务试验（AUC = 0.83）。测试完成时间在单任务和双任务条件下提供了出色的组间区分能力。然而，双任务试验期间的认知表现仅显示出微弱的临床实用性（AUC≤0.67）。
串联步态评估在单任务条件下可能仅需两次试验，在双任务条件下仅需一次试验即可有效区分脑震荡组和对照组。这种方法可能会提高测试的可行性（时间要求），同时保持出色的区分能力。
