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Updated: Jan 10, 2026
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A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
13.8K
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
Summary
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.
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.
