Measuring Recovery With Ecological Momentary Assessment in a Randomized Trial of Exercise After Sport-Related Concussion

Abstract

Objective: 

Investigate the reliability of concussion symptoms captured through ecological momentary assessment (EMA) and compare time with recovery based on 3 definitions of symptomatic recovery and the date of clinical clearance to begin the return-to-play (RTP) process.

Design: 

We used a mobile app with EMA to monitor concussion symptoms as part of a multicenter randomized controlled trial.

Setting: 

Three sports medicine practices.

Participants: 

Patients between 13 and 18 years old with sport-related concussion were prompted to complete the Post-Concussion Symptom Inventory daily over 4 weeks.

Interventions: 

None.

Main Outcome Measures: 

We compared the elapsed days to reaching the 4 outcomes using scatterplots and Kaplan–Meier curves.

Results: 

Among 118 participants, symptoms reported into the app had excellent agreement with symptoms reported at a clinical visit on the same day (intraclass correlation coefficient = 0.97). Most (>50%) participants reached “specific symptom return to preinjury levels,” “overall symptom return to preinjury levels,” and “current symptom resolution” based on EMA symptom reports between several days and 1 week before achieving “clinical clearance to RTP” determined at a clinical visit, which had 100% sensitivity, but between 56.3% and 78.1% specificity, relative to the app-measured symptom outcomes.

Conclusions: 

Time until symptom recovery varies based on the chosen definition of symptomatic recovery but is a more precise correlate with clinical clearance to begin the RTP process when defining symptom recovery as a return to a preinjury baseline level of symptomatology. Real-time symptom monitoring may be beneficial clinically, allowing providers to assess patients' recovery status and make more timely and remote treatment recommendations.