Establishing the Reliability and Validity of A Novel Ecological Momentary Assessment Tool in Healthy College-Aged Athletes: A Foundation for Future Concussion Research

Allie J Tracey; Douglas J Wiebe; Kimberly S Kelly; Nicole L Hoffman; Tracey Covassin; Abigail C Bretzin

doi:10.1097/HTR.0000000000001149

Establishing the Reliability and Validity of A Novel Ecological Momentary Assessment Tool in Healthy College-Aged Athletes: A Foundation for Future Concussion Research

J Head Trauma Rehabil. 2026 Mar 13. doi: 10.1097/HTR.0000000000001149. Online ahead of print.

Authors

Allie J Tracey¹, Douglas J Wiebe, Kimberly S Kelly, Nicole L Hoffman, Tracey Covassin, Abigail C Bretzin

Affiliation

¹ Author Affiliations: Jefferson Moss Rehabilitation Research Institute, Elkins Park, PA (Dr Tracey); Department of Kinesiology, Michigan State University, East Lansing, MI (Drs Hoffman and Covassin); Injury Prevention Center, University of Michigan, Ann Arbor, MI (Drs Wiebe and Bretzin); and Department of Counseling, Educational Psychology & Special Education, Michigan State University, East Lansing, MI (Dr Kelly).

PMID: 41820268
DOI: 10.1097/HTR.0000000000001149

Abstract

Objective: This study evaluated the psychometric properties and clinical feasibility of administering a post-concussion symptom checklist and real-time assessments of psychological health-related quality of life (PHRQoL) in healthy college-aged individuals via a mobile, ecological momentary assessment text messaging platform, Recovering Concussion Update on Progression of Symptoms (ReCoUPS).

Setting: University laboratory setting.

Participants: Healthy college-aged athletes (n = 93; 64 female, 29 male; µ age = 21.37 ± 2.63 years) who currently play or recently (i.e., within the past year) played a sport and had not sustained a concussion within the past 6 months.

Design: Test-retest reliability design.

Main measures: Healthy participants enrolled in the ReCoUPS platform using their cell phone number completed daily, randomly timed text message surveys for 7 consecutive days. Each survey included 30 questions from the Sport Concussion Tool, Version 6 (SCAT6) symptom checklist and modified momentary versions of the PROMIS Emotional Distress Short Forms for Anxiety and Depression (PROMIS-SF Anxiety and PROMIS-SF Depression). Eight days after enrollment, participants completed recalled PROMIS-SF inventories ("within the past 7 days"). Response rates to ReCoUPS surveys were calculated to assess feasibility. Reliability and validity of momentary PROMIS-SF measures were evaluated using Cronbach's alpha, intraclass correlation coefficients (ICCs) with 95% confidence intervals (95%CI), Cohen's kappa ( κ ), and Spearman's rho correlation coefficients (r s ).

Results: Most participants (n = 80, 86.0%) completed over 70% of daily ReCoUPS surveys. Momentary assessments of PROMIS-SFs demonstrated acceptable reliability (Anxiety α = .80; Depression α = .91) and moderate to excellent agreement with their original recalled measures (Anxiety: ICC = 0.99(95%CI, 0.99-1.00), κ = 0.44; Expected: 51.73%, Actual: 73.12%, P < .001; Depression: ICC = 0.99(95%CI, 0.99-1.00), κ = 0.58; Expected: 50.99%, Actual: 79.57%, P < .001). Momentary assessments of PROMIS-SFs were significantly correlated with each other, all SCAT6 symptom clusters, and total SCAT6 symptom severity (r s = 0.28-0.92, P < .001).

Conclusions: ReCoUPS performed reliably and as a feasible tool for remotely monitoring concussion symptoms and momentary PHRQoL in healthy individuals, providing a foundation for future work in a concussion population to improve stakeholders' understanding of post-concussion outcomes and optimize treatments.

Keywords: brain injuries; concussion; ecological momentary assessment; remote symptom monitoring; traumatic.