INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Majestic Complex (Posters 61-120) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #73 Multidisciplinary Treatment Outcomes in Youth with Persistent Symptoms After Concussion (PCS): Impact of Credible vs Non-Credible Effort Presentations Cody Solesbee, Nationwide Children's Hospital, Columbus, United States Kelly McNally, Nationwide Children's Hospital, Columbus, United States Sean Rose, Nationwide Children's Hospital, Columbus, United States Kathleen Shiplett, Nationwide Children's Hospital, Columbus, United States Ashley Davidson, Nationwide Children's Hospital, Columbus, United States Category: Concussion/Mild TBI (Child) Keyword 1: child brain injury Keyword 2: treatment outcome Keyword 3: performance validity Objective: Noncredible effort is a common finding when evaluating youth with PCS, though it is not known whether those patients who display noncredible effort respond differently to clinical interventions. We sought to compare multidisciplinary treatment outcomes of youth with PCS displaying credible vs. noncredible effort on cognitive testing. Participants and Methods: 82 participants (ages 5-20, M = 15.25, SD = 2.84) were referred to a multidisciplinary clinic to evaluate and address persisting symptoms after concussion. 58% of participants were female and 42% were male, with 53% reporting a history of anxiety or depression. Participants completed an initial assessment visit and returned for an individualized multidisciplinary treatment plan including one to four sessions with neurology, neuropsychology, physical therapy, and/or supervised exercise progression. Initial visits were, on average, 99 days after the injury occurred. Performance validity on the cognitive screening was measured using Green’s Medical Symptom Validity Test; MSVT). Noncredible effort was defined as a score of < 85 on immediate recognition, delayed recognition, or consistency. Participants were grouped based on demonstrating credible or non-credible effort. Treatment outcomes included self-reported symptom ratings from the Sport Concussion Assessment Tool—5^th edition (SCAT-5) as well as time since injury to clearance from concussion-related activity restrictions. Results: 22% of participants demonstrated non-credible effort on the MSVT. Across time points, patients with non-credible effort reported significantly higher levels of PCS on the SCAT-5 (PCS at treatment onset: M = 72.92, SD = 34.82; PCS at end of treatment: M = 33.63, SD = 37.71) compared to participants with credible effort (PCS at treatment onset: M = 48.58, SD = 32.47; PCS at end of treatment: M = 12.19, SD = 23.13). However, both groups demonstrated significantly reduced symptoms with treatment t(80) = -13.75, p < .001. When co-varying for initial symptom burden, change from pre to post treatment ratings did not significantly differ between groups, suggesting that treatment effects were not different between groups F(1,29) = 2.06, p = .16. Similarly, the credible effort group (M = 48.98 days, SD = 32.59) did not significantly differ from the non-credible effort group (M = 60.63 days, SD = 30.21) regarding their time to clearance F(1,47) = .87, p = .36. Conclusions: Youth with PCS who present with noncredible effort on cognitive testing tend to self-report higher levels of PCS symptoms. That said, multidisciplinary intervention may be beneficial for reducing symptoms in patients with credible or noncredible effort. These data suggest that clinicians should consider typical multidisciplinary treatment approaches when working with a patient with noncredible effort but should focus more on functional outcomes rather than using overall symptom levels to gauge treatment progress and sports clearance.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #73

Multidisciplinary Treatment Outcomes in Youth with Persistent Symptoms After Concussion (PCS): Impact of Credible vs Non-Credible Effort Presentations

Cody Solesbee, Nationwide Children's Hospital, Columbus, United States
Kelly McNally, Nationwide Children's Hospital, Columbus, United States
Sean Rose, Nationwide Children's Hospital, Columbus, United States
Kathleen Shiplett, Nationwide Children's Hospital, Columbus, United States
Ashley Davidson, Nationwide Children's Hospital, Columbus, United States

Category: Concussion/Mild TBI (Child)

Keyword 1: child brain injury
Keyword 2: treatment outcome
Keyword 3: performance validity

Objective:

Noncredible effort is a common finding when evaluating youth with PCS, though it is not known whether those patients who display noncredible effort respond differently to clinical interventions. We sought to compare multidisciplinary treatment outcomes of youth with PCS displaying credible vs. noncredible effort on cognitive testing.

Participants and Methods:

82 participants (ages 5-20, M = 15.25, SD = 2.84) were referred to a multidisciplinary clinic to evaluate and address persisting symptoms after concussion. 58% of participants were female and 42% were male, with 53% reporting a history of anxiety or depression. Participants completed an initial assessment visit and returned for an individualized multidisciplinary treatment plan including one to four sessions with neurology, neuropsychology, physical therapy, and/or supervised exercise progression. Initial visits were, on average, 99 days after the injury occurred. Performance validity on the cognitive screening was measured using Green’s Medical Symptom Validity Test; MSVT). Noncredible effort was defined as a score of < 85 on immediate recognition, delayed recognition, or consistency. Participants were grouped based on demonstrating credible or non-credible effort. Treatment outcomes included self-reported symptom ratings from the Sport Concussion Assessment Tool—5^th edition (SCAT-5) as well as time since injury to clearance from concussion-related activity restrictions.

Results:

22% of participants demonstrated non-credible effort on the MSVT. Across time points, patients with non-credible effort reported significantly higher levels of PCS on the SCAT-5 (PCS at treatment onset: M = 72.92, SD = 34.82; PCS at end of treatment: M = 33.63, SD = 37.71) compared to participants with credible effort (PCS at treatment onset: M = 48.58, SD = 32.47; PCS at end of treatment: M = 12.19, SD = 23.13). However, both groups demonstrated significantly reduced symptoms with treatment t(80) = -13.75, p < .001. When co-varying for initial symptom burden, change from pre to post treatment ratings did not significantly differ between groups, suggesting that treatment effects were not different between groups F(1,29) = 2.06, p = .16. Similarly, the credible effort group (M = 48.98 days, SD = 32.59) did not significantly differ from the non-credible effort group (M = 60.63 days, SD = 30.21) regarding their time to clearance F(1,47) = .87, p = .36.

Conclusions:

Youth with PCS who present with noncredible effort on cognitive testing tend to self-report higher levels of PCS symptoms. That said, multidisciplinary intervention may be beneficial for reducing symptoms in patients with credible or noncredible effort. These data suggest that clinicians should consider typical multidisciplinary treatment approaches when working with a patient with noncredible effort but should focus more on functional outcomes rather than using overall symptom levels to gauge treatment progress and sports clearance.