Letters to the Editor
It would appear that Dr. Shuttleworth-Edwards (1) failed to grasp the fundamental issues addressed in the article. She suggests that I am guilty of formulating a "straw man argument" because she perceives me as criticizing baseline testing without considering the fact that baseline testing is only useful for comparison with postinjury testing. I am, quite frankly, at a loss regarding how to respond to this. What other possible purpose could baseline testing serve?
Her second point seems to be that clinical judgment should trump evidence-based medicine. I would respectfully disagree with that position. "Case-based research" is nothing more than anecdote. Anecdote is only useful in the absence of evidence and, even then, often is misleading.
In addition, she seems to confuse clinical neuropsychological evaluations with baseline testing. The sole purpose and point of the baseline testing methodology are to make a determination of "recovery" on the basis of test-retest data and to be able to arrive at a statistically derived probability of return to baseline. This involves a mathematical algorithm, and the psychometric requirements of this process are fairly straightforward. She fails to address the issue of inadequate reliability of the ImPACT test, despite her endorsement thereof. Would she promote the use of a thermometer that was so unreliable that it would classify 40% of healthy individuals as pyretic and 40% of pyretic individuals as healthy? Would clinical judgment be sufficient to overcome the shortcomings of such a thermometer?
Finally, Dr. Shuttleworth-Edwards failed to address the issue of risk. It is interesting to me that so much fervor can be expended in defense of a methodology without any reference to the risks that presumably are being modified by that methodology. What is prevented or improved by administering the ImPACT test to an athlete under any circumstance?
Christopher Randolph, PhD
Loyola University Medical Center
1. Shuttleworth-Edwards AB. Response to article on baseline neuropsychological testing: throwing away clinical gold with the statistical bathwater. Curr. Sports Med. Rep.