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Measurement Error in the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT): Systematic Review
Bara Alsalaheen1, Kayla Stockdale, Dana Pechumer
1Department of Physical Therapy, University of Michigan-Flint (Dr Alsalaheen and Mss Stockdale and Pechumer) and NeuroSport Research Laboratory, University of Michigan, Ann Arbor (Dr Broglio).
The Journal of Head Trauma Rehabilitation
|August 21, 2015
Summary
The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) shows poor to moderate reliability for most scores, questioning its use in concussion management. Clinicians and researchers should carefully consider these findings when using ImPACT for medical clearance or outcome evaluation.
Area of Science:
- Neuroscience
- Sports Medicine
- Clinical Psychology
Background:
- The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is widely used in concussion research and clinical practice.
- Assessing the reliability of ImPACT scores is crucial for accurate concussion diagnosis and management.
Purpose of the Study:
- To conduct a systematic literature review on the reliability of ImPACT cognitive testing scores.
- To evaluate the consistency and accuracy of ImPACT in assessing cognitive function after concussion.
Main Methods:
- A systematic review of studies from PubMed, CINAHL, and PSYCHINFO databases was performed.
- Ten studies meeting inclusion criteria were analyzed using the STROBE instrument and custom items.
- Reliability was assessed using intraclass correlation coefficients (ICC).
Main Results:
- Most ImPACT composite scores demonstrated poor to moderate reliability (ICC <0.80), with processing speed being an exception.
- Misclassification rates for reliable change in cognitive scores ranged from 2.2% to 26% across different domains.
- Significant variability in reliability was observed for verbal memory, visual memory, processing speed, and reaction time.
Conclusions:
- The reliability of most ImPACT scores is questionable, potentially impacting clinical decisions.
- Clinicians should exercise caution when using ImPACT for return-to-play medical clearance after concussion.
- Researchers must be diligent when using ImPACT for concussion outcome evaluation or validating other measures.
