A Fully Virtual Graded Exertion Test is Safe and Feasible in Symptomatic and Asymptomatic Children with Concussion
Current graded exertion tests (GXT) for concussion management require secialized equipment and in-person supervision. The Montreal Virtual Exertion (MOVE) protocol is a telehealth compatible GXT but has only been tested in pseudo virtual conditions To determine the safety and feasibility of the MOVE protocol when administered remotely to children with concussion. Design: Prospective cohort study. Participants were recruited from the Montreal Children’s Hospital Concussion Clinic between November 2023 and June 2024. Patients: Asymptomatic (n=15, 40.8±19.2 days after concussion) and symptomatic (n=15, 28.7±23 days after concussion) children with concussion (aged 12.9 ± 2.6 years, nfemales=18) Participants completed the MOVE protocol and a 24hr follow-up visit over Zoom. The MOVE protocol consists of seven plyometric exercises performed for 60sec, with 60secs of rest between stages. Safety (adverse events) and feasibility measures (protocol, outcomes, intensity, and technology categories) were collected. Linear mixed models evaluated exercise intensity outcomes, with all other outcomes analyzed using chi-square tests. Participants in the symptomatic (n=1) and asymptomatic (n=1) groups experienced a minor adverse event (symptom increase ≥10 points on the PCSI at 24h visit); however, no major adverse events were reported. Heart rate (ΔHR= 78.7± 33.6, p<0.001) and rate of perceived exertion (ΔRPE= 4.87±1.50, p<0.001) change scores significantly increased throughout the MOVE protocol, but no main effect of group or interaction effects were observed. Feasibility outcomes were less likely to be captured during the rest period for asymptomatic children (outcomes not collected on time on 33 (31.4%) occasions) than symptomatic children (11 (11.7%) occasions; χ2(1)=10.1, p< 001). Otherwise, all outcomes met the a priori definition of feasibility The MOVE protocol can be safely and feasibly administered virtually. A no-equipment, virtual GXT can remove barriers to exercise testing and broaden access to best practice concussion management strategies.ABSTRACT
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Contributor Notes
*Contributed equally as co-first authors
Julie Coupal: julie.coupal@gmail.com
Daria Shabanova: dariash2000@hotmail.com
Isabelle Gagnon: isabelle.gagnon8@mcgill.ca
Lisa Grilli: lisa.grilli@muhc.mcgill.ca
Christine Beaulieu: Christine.Beaulieu@MUHC.MCGILL.CA
Elizabeth Teel: elizabeth.teel@concordia.ca