The use of an intensive physical exertion test as a final return to play measure in concussed athletes: a prospective cohort
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OBJECTIVES: To examine the utility of a novel physical exertion test developed by the Chicago Blackhawks medical staff as a final return to play (RTP) clearance test in youth and young adult athletes, and to determine the relationship between participant and test variables on RTP within asymptomatic athletes diagnosed with concussion. METHODS: Once asymptomatic and following completion of all RTP steps, concussed athletes underwent the Gapski-Goodman Test (GGT) or modified GGT (mGGT) at partnered Complete Concussion Management Inc. (CCMI) clinics as part of RTP decision-making. Prospective data was collected electronically by trained CCMI clinicians utilizing the CCMI Concussion Database System. A review was conducted to examine data collected between January 2016 and February 2017. Participant and test variables were analyzed to determine relationships with pass/fail rate of the GGT/mGGT. RESULTS: A total of 759 athletes performed the GGT/mGGT in the study period. Although all asymptomatic, 14.6% of concussed athletes failed the GGT/mGGT while attempting to achieve RTP clearance. Statistically significant relationships were found between failure of the test and symptom severity score on initial presentation and self-reported history of pre-morbid anxiety. When taken together, sex, age, and pre-morbid anxiety significantly predicted the length of time between injury and RTP clearance. CONCLUSION: The GGT may identify individuals who are not ready to RTP despite a self-reported asymptomatic status and completion of all RTP steps. These results illustrate that RTP clearance decisions based on self-reported asymptomatic status at rest may be inadequate. Instead, monitored, intensive, sport-specific, physical exertion testing should be utilized to inform clinical RTP decisions.