An investigation of the effect of repeated testing and extra incentive on neurocognitive performance in non-concussed adults
Standardized neurocognitive testing is a commonly used assessment method to diagnose and manage sports-related concussion. This method involves testing athletes at preseason, and re-testing them if a concussion occurs. Athletes usually return to competition once they are symptom-free and their cognitive performance post concussion returns to their preseason cognitive performance. Although this approach in sports-related concussion management seems well-guided and clear-cut, there are a number of factors that can interfere with the accuracy of assessment. This study addressed three such factors: test-retest reliability, the effect of extra incentive on neurocognitive performance, and practice effects. 33 non-concussed UTEP collegiate students were recruited and tested serially on four occasions using the Immediate Post-Concussion Assessment and Cognitive Testing battery version 2.0 (ImPACT) with 7–8 days between testing sessions. In this single-group A-A-B-A pretest-posttest design, the dependent measures were the Verbal and Visual Memory, Reaction Time, Visual Processing Speed, and Cognitive Efficiency Index composite scores on the ImPACT battery. Participants received a one-time-only extra monetary incentive on the third test session. Time and the presence or absence of extra monetary incentive were the independent variables. Pearson correlation was applied to measure test-retest reliability for each composite score across the repeated administrations of the ImPACT battery. Repeated measures Analysis of Variance (ANOVA) and Trend Analysis were used to measure whether there was a change in performance across test sessions and to examine whether there was a change in the individual composite scores within participants before and after the monetary incentive is offered. Several test-retest reliability coefficients did not meet criteria and varied across time. Results also showed practice effects in verbal memory, visual processing speed, reaction time, and cognitive efficiency index scores. A significant linear trend was also found in visual memory, reaction time, and visual processing speed indicating improvement of performance across test sessions. Extra monetary incentive did not show any significant change when performance was compared to the second and forth test sessions. Although extra monetary incentive did not improve performance on the battery, changes of performance, practice effects, and variable test-retest reliability measures may result from other behavioral factors. Therefore, concussion assessment and management should not rely on a single neurocognitive measure or test. Multiple assessment protocol for sports-related concussion management is needed.
Bene, Edina R, "An investigation of the effect of repeated testing and extra incentive on neurocognitive performance in non-concussed adults" (2011). ETD Collection for University of Texas, El Paso. AAI3457769.