Test Retest Reliability and Reliable Change Index of Mobile Application Neurocognitive Test Among Middle and High School Athletes

Kumiko Hashida, JongSoo Lee, Troy M Furutani, William Tsushima, Kaori Tamura

2023

Context: A mobile application neurocognitive assessment has been used in place of equipment intensive computerized neurocognitive assessment protocol. A previous study reported high to very high test-retest reliability of neurocognitive assessment using the mobile application in healthy adults, but no studies have examined test-retest reliability, reliable change indices (RCIs), and sex effect in middle school and high school populations when conducted 1 year apart. Objective: The purpose of this study was to examine the test-retest reliability and RCIs of baseline data collected at 2-time points approximately 1 year apart using a mobile application neurocognitive rest in middle school and high school athletes. The secondary purpose of the study was to investigate the sex difference in neurocognitive measures. Design: Cross-sectional study. Setting: Institutional. Patients or other participants: 172 middle school and high school healthy student-athletes (mean age=13.78±1.59 years old). Main outcome measure(s): Mobile application neurocognitive rest scores (reaction time, impulse control, inspection, and memory). Results: The result from the study demonstrated that neurocognitive measures had low test-retest reliability across a 1-year time period in middle and high school settings. Upon retesting, reaction time and inspection time improved significantly in both middle and high school athletes, and impulse control showed significant improvement in middle school athletes. More athletes in middle school showed more RCI improvements compared to high school athletes. While both males and females demonstrated improvements in neurocognitive measures throughout adolescence, males outperformed females on reaction time and impulse control. Conclusions: Findings from the study indicate unacceptably low test-retest reliability of a mobile application neurocognitive test most likely due to cognitive development occurring throughout adolescence. Additionally, significant RCIs were noted. These naturally occurring improvements due to cognitive development could mask the post-concussion deficits. The findings warrant consideration of age and sex on the neurocognitive performance of middle and high school athletes. Keywords: Concussion assessment; Neurocognitive test; Reliable Change Index; Sex difference; Test-retest reliability.