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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
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Evaluating R2Play, A Novel Multidomain Return-to-Play Assessment Tool for Concussion: Mixed Methods Feasibility and

Josh Shore1,2,3, Pavreet Gill3, Danielle DuPlessis3,4

  • 1Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

JMIR Rehabilitation and Assistive Technologies
|November 25, 2025
PubMed
Summary
This summary is machine-generated.

The R2Play assessment tool shows promise for evaluating concussion recovery in youth, demonstrating good usability and physical exertion levels. This dynamic, multidomain approach aids in determining readiness for return-to-play after concussion.

Keywords:
concussiondual taskfeasibility, mixed methodspediatricsreturn to sport

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Area of Science:

  • Sports Medicine
  • Neurology
  • Rehabilitation Science

Background:

  • Current return-to-play (R2P) guidelines for concussion emphasize multimodal assessment but lack tools reflecting sport's dynamic, multidomain skill integration.
  • The R2Play tool was developed as a dynamic, multidomain assessment to address limitations in existing concussion R2P evaluations.
  • Previous work established proof of concept for R2Play, aligning its design with key objectives.

Purpose of the Study:

  • To evaluate the feasibility of the R2Play tool, assessing its usability, reliability, practicality, and safety.
  • To examine physical exertion during R2Play as a preliminary indicator of face validity.
  • To gather perspectives from clinicians and youth on R2Play's feasibility, face validity, value, and challenges.

Main Methods:

  • A convergent parallel mixed methods design was employed, combining quantitative feasibility measures with qualitative interview data.
  • Rehabilitation clinicians and youth post-concussion completed R2Play assessments, followed by semistructured interviews.
  • Feasibility was measured by usability (System Usability Scale), practicality (duration), reliability (technical issues), and safety (adverse events); face validity was assessed via exertion metrics and participant feedback.

Main Results:

  • Feasibility criteria were met or approached across all domains, with good-to-excellent clinician-rated usability (SUS=84.00±6.02).
  • Assessments were practical (26.50±6.02 min) and safe, with no adverse events; R2Play elicited vigorous exertion (peak HR=90.10±5.78% age-predicted max HR), meeting exertion targets for 9/10 youth.
  • Clinician and youth feedback indicated R2Play effectively captures sport-specific physical, cognitive, and perceptual demands, highlighting its value for R2P readiness and rehabilitation planning.

Conclusions:

  • The R2Play tool demonstrates potential feasibility and face validity for assessing concussion recovery in youth, supported by excellent usability and vigorous exertion demands.
  • Initial findings suggest R2Play can fill critical gaps in the concussion return-to-play process.
  • Further research is planned to confirm cross-site feasibility and establish content validity by analyzing the physical, cognitive, and perceptual demands of R2Play levels.