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Updated: Jul 13, 2026
A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
Association Between First Attempt Buffalo Concussion Treadmill Test and Days to Recovery in 855 Children With
Rahim Lalji1,2,3, Cesar A Hincapié1,2,3, Alison Macpherson4
1EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
Insights
The Buffalo Concussion Treadmill Test (BCTT) can help predict recovery time after sport-related concussion (SRC) in children. Exercise intolerance on the BCTT, performed 10-21 days post-SRC, was linked to a longer recovery period.
Area of Science:
- Pediatric Sports Medicine
- Neurology
- Clinical Research
Background:
- Sport-related concussion (SRC) recovery in children is variable.
- The prognostic value of post-acute phase assessments like the Buffalo Concussion Treadmill Test (BCTT) is not well understood.
Purpose of the Study:
- To evaluate the prognostic value of the BCTT, performed 10-21 days after SRC, for predicting recovery time in children.
- To determine if BCTT exercise intolerance adds prognostic information beyond other clinical factors.
Main Methods:
- Historical clinical cohort study involving 855 children diagnosed with SRC.
- Data collected on participant, injury, and clinical process characteristics.
- Focus on BCTT exercise intolerance assessed 10-21 days post-injury.
Main Results:
- Children with exercise intolerance on BCTT experienced an average of 13 additional days to recovery.
- Each day delay in BCTT testing post-SRC was associated with a 1-day recovery delay.
- Prior concussion history also predicted a longer recovery duration.
Conclusions:
- BCTT exercise intolerance is associated with delayed recovery in children post-SRC.
- While informative, the BCTT result was not a strong independent prognostic factor for recovery duration.
Objective:
Little is known about the prognostic value of the Buffalo Concussion Treadmill Test (BCTT) after the acute phase of sport-related concussion (SRC). We examined the added prognostic value of the BCTT performed 10 to 21 days after SRC in children, in addition to participant, injury, and clinical process characteristics on days to recovery.
Design:
Historical clinical cohort study.
Setting:
Network of approximately 150 Canadian multidisciplinary primary-care clinics.
Participants:
855 children (mean age 14 years, range 6-17 years, 44% female) who presented between January 2016, and April 2019 with SRC.
Assessment Of Risk Factors:
Participant, injury, and clinical process characteristics, with focus on BCTT exercise intolerance assessed 10 to 21 days after injury.
Outcome:
Days to clinical recovery.
Results:
Children who were exercise intolerant experienced an increase of 13 days to recovery (95% CI, 9-18 days). Each additional day between SRC and first BCTT was associated with a recovery delay of 1 day (95% CI, 1-2 days), and prior history of concussion was associated with a recovery delay of 3 days (95% CI, 1-5 days). Participant, injury, and clinical process characteristics, and the first attempt BCTT result explained 11% of the variation in recovery time, with 4% accounted for by the BCTT.
Conclusion:
Exercise-intolerance assessed 10 to 21 days after SRC was associated with delayed recovery. However, this was not a strong prognostic factor for days to recovery.
