Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Assessments used after concussion provide strong diagnostic accuracy and aid in initial healthcare planning, but can have limited utility after the acute timeframe. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS) to address these limitations. To evaluate the psychometric properties of FANS, including test-retest reliability, minimal detectable change, and divergent validity. Repeated measure design at two-timepoints, 14-days apart. Clinical laboratory. Seventeen healthy, physically active individuals (age:21.9±3.2years, 58.8% female; 76.5% no lifetime concussion history). Participants completed FANS at two timepoints, and conventional clinical assessments (symptom checklist, balance, computerized neurocognitive testing) at the first timepoint. FANS examined 7-cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, delayed visual memory) through incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients (ICC3,k) with 95% confidence intervals (95% CI) and Pearson r correlations to evaluate test-retest reliability and divergent validity. All FANS outcomes displayed acceptable test-retest reliability (ICCs ≥ 0.63), with the lowest being verbal memory’s interference subtest. Standard errors of measurement and minimal detectable changes overall displayed small values relative to score ranges. Correlations between FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeding the divergent validity threshold with computerized neurocognitive testing reaction time (r range: -0.79-0.77). FANS overall displayed acceptable test-retest reliability comparable to more traditional neurocognitive test platforms, and acceptable divergent validity. FANS reaction time and processing speed may partially overlap with computerized neurocognitive testing reaction time, and warrants further examination in a clinical population. Though FANS is reliable and valid for use, future research is needed to establish FANS utility for return-to-sport readiness.ABSTRACT
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