Diagnostic tools for return-to-play decisions in sports-related concussion

Abstract

Research has improved the understanding of sports related concussion (SRC), and several classification systems and guidelines are available in the literature. The exact timing and clearing of athletes for return-to-play (RTP) is still based primarily on subjective reports of concussion symptoms, however symptoms link poorly to objective recovery. Current literature suggest that symptoms alone cannot accurately identify either all concussed athletes or their recovery. The difficult task of interpreting which symptoms are directly related to concussion, and which are related to other conditions, speaks for an increased focus on the RTP process itself. This study examines the literature on neurocognitive assessments and their importance as indicators of accurate timing of when athletes can return to either ball training with duels or the playing field. Entries in three electronic databases (PubMed, Web of Science, and SURF) were searched from January 2000 to June 2022. Search terms were concussion, mild traumatic brain injury (mTBI), sport, athlete, expert, elite, professional, diagnostic, testing, return to play, management, neurocognitive, and cognitive. Inclusion criteria comprised performance-based participation in a team sport and being in the age range of possible peak performance (18–40 years). In addition, only studies with pre-post designs were considered. The PEDro scale was used to assess methodological quality. The methodological quality of the fifteen included studies ranged from 5 (one study) to 6 (fourteen studies) from a maximum of 10. Despite being symptom-free, athletes in all fifteen studies showed lower performance compared to controls on tests of visual and verbal memory (approx. 3–5% deficit) and on processing speed (approx. 6% deficit) after mTBI. All studies report specific neurocognitive deficits after mTBI, although the athletes were declared clinically symptom-free. Therefore, the systematic consideration of neurocognitive parameters in RTP decision making is recommended, especially in light of subsequent muscular injuries of the lower musculoskeletal system, recurrence of mTBI, and residual neurodegenerative disorders.