Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool

Kori J Durfee; Philip Schatz; Anthony P Kontos; Michael W Collins; Melissa N Womble; Sabrina Jennings; Madison F Ceola; R J Elbin

doi:10.4085/1062-6050-0325.23

Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool

J Athl Train. 2024 Jan 20. doi: 10.4085/1062-6050-0325.23. Online ahead of print.

Authors

Kori J Durfee¹, Philip Schatz², Anthony P Kontos³, Michael W Collins³, Melissa N Womble⁴, Sabrina Jennings⁴, Madison F Ceola¹, R J Elbin¹

Affiliations

¹ Departement of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas, USA.
² Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA.
³ UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Inova Medical Group, Department of Orthopedics and Sports Medicine, Inova Sports Medicine Concussion Program, Fairfax, Virginia, USA.

PMID: 38243732
DOI: 10.4085/1062-6050-0325.23

Abstract

Context: The Concussion Clinical Profile Screening Tool (CP Screen) self-report concussion symptom inventory that is often administered at weekly intervals. However, 1-week reliable change indices (RCI) for clinical cutoffs and the test-retest reliability of the CP Screen is unknown.

Objective: Document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for males and females.

Design: Case Series.

Setting: A large US university.

Patients or other participants: 173 healthy college students.

Main outcome measure(s): Participants completed two administrations of the CP Screen 7 days apart; CP Screen items yield five clinical profiles and two modifiers. Spearman rho coefficients (rs), intraclass correlation coefficients (ICCs) single measures and Unbiased Estimates of Reliability (UER) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. RCI values and cutoff scores are provided at 90%/95% confidence intervals (CI). All analyses were performed for the total sample and separately for males and females.

Results: RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for males were as follows: Ocular, Vestibular >2/>4, Anxiety/Mood, Cognitive/Fatigue, Migraine>3/>3, Sleep >4/>6, and Neck>2/>2. RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for females were as follows: Anxiety/Mood≥2/≥4; Cognitive/Fatigue, Migraine, Ocular, Vestibular, Sleep≥3/≥3; and Neck≥1/≥1. Correlations for CP ranged from .51 (Migraine) to .79 (Anxiety/Mood) for the total sample, .48 (Migraine) to .84 (Vestibular) for males, and .51 (Migraine) to .77 (Ocular) for females. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC: .64-.82; UER: .79-.90), males (ICC: .60-.87; UER: .76-.94), and females (ICC: .64-.80; UER: .78-.89).

Conclusion: The CP Screen is reliable and stable across a 1-week interval, and established RCIs for males and females can help identify meaningful change throughout recovery.

Keywords: Clinical cutoffs; Clinical profiles; Concussion; Symptoms.