Minimal detectable change for the ImPACT test administered remotely

Abstract

Context The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is one of the most widely used computerized neurocognitive assessment batteries in athletics, serving as both a baseline and post-injury assessment. It has become increasingly popular to administer the ImPACT baseline test in an un-supervised remote environment, however, it is unknown if the lack of supervision affects the test-retest reliability. Objective To establish the minimal detectable change (MDC) of composite scores from the ImPACT test when administered to National Collegiate Athletic Association (NCAA) Division I student-athletes in an un-supervised remote environment before two consecutive athletic seasons. Design Cross-Sectional Setting Participants were provided with a unique link and detailed written instructions on how to complete the ImPACT test at home. Patients or Other Participants NCAA Division I student-athletes Main Outcome Measure(s) Remote ImPACT baseline test results from the 2020–2021 and 2021–2022 athletic seasons were analyzed. The MDC was calculated at the 95%, 90%, and 80% confidence intervals for each of the ImPACT composite scores, as well as the average and standard deviation. Results The MDC at the 95% confidence interval was found to be 18.6 for the verbal memory composite score, 24.44 for visual memory, 8.76 for visual motor, 0.14 for reaction time, and 6.13 for impulse control. One-way repeated measures MANOVA, repeated measures ANOVA, and Wilcoxon signed-ranks test all suggest no significant difference between the composite scores and impulse control between time points. Conclusions The ImPACT test composite scores and impulse control did not significantly change between the two remote testing time points when administered approximately a year between testing. Our study suggests the MDC serve as a clinician's guide for evaluating changes in ImPACT baseline scores and in making clinical judgments on sports-related concussion when the test is administered at home.