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Mobile Ecological Momentary Assessment of Postconcussion Symptoms and Recovery Outcomes

Sufrinko, Alicia M. PhD; Howie, Erin K. PhD; Charek, Daniel B. PhD; Elbin, R. J. PhD; Collins, Michael W. PhD; Kontos, Anthony P. PhD

The Journal of Head Trauma Rehabilitation: February 27, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000474
Original Article: PDF Only

Objective: Evaluate mobile ecological momentary assessment (mEMA) as an approach to measure sport-related concussion (SRC) symptoms, explore the relationships between clinical outcomes and mEMA, and determine whether mEMA was advantageous for predicting recovery outcomes compared to traditional symptom report.

Setting: Outpatient concussion clinic.

Participants: 20 athletes aged 12 to 19 years with SRC.

Methods: Prospective study of mEMA surveys assessing activity and symptoms delivered via mobile application (3 time blocks daily) and clinical assessment at visit 1 (<72 hours postinjury) and visit 2 (6-18 days postinjury). Linear mixed models examined changes in mEMA symptoms over time and relationships among simultaneous report of activity type (cognitive, physical, sedentary, vestibular) and symptoms. Linear regressions evaluated the association among symptoms for activity types and clinical outcomes.

Main Measures: mEMA symptom scores, Post-Concussion Symptom Scale, neurocognitive testing, vestibular/oculomotor screening (VOMS).

Results: mEMA response rate was 52.4% (N =1155) for prompts and 50.4% per participant. Symptoms were lower in the morning (P < .001) compared with afternoon and evening. Higher mEMA symptoms were reported during vestibular compared with physical (P = .035) and sedentary (P = .001) activities. mEMA symptoms were positively associated with Post-Concussion Symptom Scale (PCSS) (P = .007), VOMS (P = 0.001-0.002), and recovery time (P < .001), but not neurocognitive scores. mEMA symptom score (P = .021) was a better predictor of recovery time than PCSS at either clinic visit.

Conclusion: mEMA overcomes barriers of traditional symptom scales by eliminating retrospective bias and capturing fluctuations in symptoms by time of day and activity type, ultimately helping clinicians refine symptom management strategies.

UPMC Sports Medicine Concussion Program (Drs Sufrinko, Charek, Collins, and Kontos) and Department of Orthopaedic Surgery, University of Pittsburgh (Drs Sufrinko, Collins, and Kontos), Pittsburgh, Pennsylvania; and Department of Health, Human Performance, and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville (Drs Howie and Elbin).

Corresponding Author: Alicia M. Sufrinko, PhD, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA 15203 (

Steven D. Manners Faculty Development Award at the University of Pittsburgh.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Michael W. Collins is a cofounder and 10% shareholder of ImPACT Applications, Inc. Other authors declare no conflicts of interest.

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