Valid but invalid: suboptimal impact© baseline performance in university athletes

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ObjectiveTo investigate the frequency of valid yet suboptimal ImPACT© performance in college athletes.DesignDescriptive.SettingResearch Laboratory.Participants Division 1 University athletes (n=769) from 22 different sports.InterventionThe Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to participants per the institution’s concussion management protocol at baseline in groups <2. Participants who scored <16th percentile compared to ImPACT normative data on any neurocognitive index (potentially suggesting suboptimal effort) were re-administered ImPACT up to two additional times.Outcome measuresDescriptive analyses were used to examine validity indicators and individual Verbal and Visual Memory, Visual Motor Speed and Reaction Time ImPACT composite scores in initial and subsequent administrations.Main resultsBased on ImPACT’s validity criteria, 1% (9/769) of administrations were invalid and 14.6% (112/769) had one or more composite scores <16th percentile but were considered valid. After one re-administration 71.4% (80/112) achieved scores >16th percentile and an additional 18/32 scored >16th percentile after a third administration.ConclusionsApproximately 16% of ImPACT records were flagged as invalid or had one or more composite scores <16th percentile, potentially indicative of suboptimal performance. Upon readministration, 88% of those participants scored >16th percentile. Clinicians must be aware of suboptimal ImPACT performance as it limits the clinical utility of the baseline assessment. Further research is needed to address factors leading to “valid” but invalid baseline performance.Competing interestsNone.

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