Post-Concussion Differences Between Buffalo Concussion Treadmill Test (BCTT) and Modified Dynamic Exertion (mEXiT) Test

Comparing Symptom Provocation and Physiological Response Between Buffalo Concussion Treadmill Test (BCTT) Protocol and Modified Dynamic Exertion Test (mEXiT) Post Concussion

This study aims to compare symptom provocation, physiologic response, and rate of perceived (RPE) between the Buffalo Concussion Treadmill Test (BCTT) and a Modified Dynamic Exertion (mEXiT) test after sport related concussion in adolescents aged 14-17. Participants will be enrolled at their initial concussion clinical visit within 14 days of their injury, and randomly assigned to either the BCTT or mEXiT group. Participants will complete a single visit.

Study Overview

• Status: Recruiting
• Conditions: Mild Traumatic Brain Injury
• Intervention / Treatment: Other: BCTT; Other: Dynamic ExIT

Detailed Description

The Buffalo Concussion Treadmill Test is a well established test to determine intensity of exercise without significant symptoms provocation after sport related concussion.

This study will help determine if there is a difference in type of symptom response between the two tests, due to the dynamic changes of direction and strain on the vestibular system with the m-EXiT group. The investigators hypothesize there will not be a significant difference between the two groups in time to clearance to return to sport despite allowing for higher symptoms earlier on in recovery.

High school athletes who have been diagnosed with a sport-related concussion will be randomly assigned to complete either the BCTT or the modified dynamic EXiT test (m-EXiT). The BCTT group will follow the established protocol and exercise to an increase of 2/10 symptoms on a visual analog scale (VAS) or 17/20 on rate of perceived effort (RPE) scale. The m-EXiT test will complete a shortened version of the dynamic EXiT test, but will stop if participants have an increase of greater than 4 points of headache, dizziness or nausea or RPE of 17/20. Symptoms, heart rate, and RPE will be measured through out both tests as well as Post-Concussion Symptom Scale (PCSS), Vestibular Ocular Motors Screening (VOMS), blood pressure and heart rate will be administered before and after testing. The time (in days) to recovery, will also be recorded from the medical record to determine if there is a difference between the two groups.

The primary outcome for the study will be symptoms post test and heart rate. Secondary measures include: Post Concussion Symptom Score (PCSS), Clinical Profiles Screening (CP-Screen), Vestibular Ocular Motor Screening (VOMS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7) and blood pressure. These will be collected at one visit with participants, there are no follow-up or subsequent visits for this study.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anthony P Kontos, PhD; Phone Number: 412-904-1298; Email: akontos@pitt.edu
• Study Contact Backup: Name: Sarah Ostop, DPT; Phone Number: 724-720-3050; Email: sterlingse@upmc.edu

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15203
      • Recruiting
      • UPMC/Univ of Pgh Sports Medicine Concussion Research Program
      • Contact: Cynthia Holland, MPH; Phone Number: 412-904-1298; Email: clh197@pitt.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with a sport related concussion within 14 days of injury
• Participants referred to exertion therapy after a trained clinician from University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program has interpreted neurocognitive, vestibular, and clinical interview outcomes and determined the participant is capable of completing structured exercise.

Exclusion Criteria:

• Medically cleared from a previous concussion within the past 6 months
• More than 2 previous concussions (excluding current injury)
• History of brain surgery or traumatic brain injury (TBI) (based on Glasgow Coma Scale of <13)
• History of neurological disorder (seizure disorder, epilepsy, brain tumors or malformations)
• Current history of pre-existing vestibular disorder or oculomotor condition
• Currently taking antidepressant, anticoagulant, beta-blocker, or anticonvulsant prescription medications
• Incapable of treadmill running up to 5.5 miles per hour (mph) and 4.5 mph for males and females respectively (self-reported).
• Diagnosed with a cardiac, peripheral, or cerebrovascular disease (type 1 or 2 diabetes, or renal disease.
• Experienced chest pain or shortness of breath while at rest or with mild exertion.
• Lose balance because of dizziness or have lost consciousness (aside from concussion) from exertion
• Currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by physical activity
• Been told by a doctor to only conduct physical activity under medical supervision.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Buffalo Concussion Treadmill Test (BCTT); Participants in this group will complete the Buffalo Concussion Treadmill Test (BCTT). This involves individuals walking at 5.8 km/hr. (3.6 mph) at a 0.0% incline (5.1 km/hr. [3.2 mph] if below 5' 10" tall), the treadmill incline is increased 1 degree each minute for the first 15 minutes, then speed increased 0.64 km/hr. (0.4 mph) each minute thereafter.	Other: BCTT; Participants will complete the Buffalo Concussion Treadmill Test, which involves individuals walking at 5.8 km/hr. (3.6 mph) at a 0.0% incline (5.1 km/hr. [3.2 mph] if below 5' 10" tall), the treadmill incline is increased 1 degree each minute for the first 15 minutes, then speed increased 0.64 km/hr. (0.4 mph) each minute thereafter.
Experimental: Modified EXiT Test (mEXiT); Participants in this group will complete the modified EXiT test (mEXiT). Participants will complete a 12 minute treadmill interval program followed by a dynamic circuit (10 squat jumps, 10 side to side push ups and 10 medicine ball rotations), jump ball toss, zig zag agility and arrow agility. Parameters will be recorded the same as the established dynamic EXiT test; heart rate and RPE will be recorded at 0, 2, 6:30 and 12 minutes of the treadmill program as well as after the second trial of each activity. The time to complete two trials of the zig zag agility and arrow agility will also be recorded.	Other: Dynamic ExIT; The modified EXiT test will complete a 12 minute treadmill interval program followed by a dynamic circuit (10 squat jumps, 10 side to side push ups and 10 medicine ball rotations), jump ball toss, zig zag agility and arrow agility. Parameters will be recorded the same as the established dynamic EXiT test; heart rate and RPE will be recorded at 0, 2, 6:30 and 12 minutes of the treadmill program as well as after the second trial of each activity. The time to complete two trials of the zig zag agility and arrow agility will also be recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physiological response to dynamic or aerobic test (HEART RATE)	Participants will have their heart rate taken before the exercise protocol, then monitored throughout the test and after they complete the BCTT or mEXiT.	Visit 1 (baseline) (pre, during, and post testing) 90 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post Concussion Symptom Scale	Participants rate on a 7 point Likert scale the presence and severity of 22 common concussion-related symptoms, including, but not limited to headache, dizziness, confusion, fogginess. The scale is 0-6 (0=none, 1-2=mild, 3-4=moderate, 5-6=severe). Higher the score, the more symptoms participant is reporting.	Visit 1 Baseline (60-90 minutes), participants only complete one visit
Patient Health Questionnaire (PHQ-9)	The PHQ-9 is a 9 item questionnaire that assesses the presence and severity of depression over the last 2-weeks. Total score ranges from 1-27, with higher scores indicating higher level of depression. Scale is 0-4 (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day). Higher scores indicate worse reporting of issues.	Visit 1 Baseline (60-90 minutes), participants only complete one visit
Generalized Anxiety Disorder (GAD-7)	The GAD-7 is a seven item self-reported questionnaire that measures severity of symptoms regarding anxiety. Responses are 0 = not at all, 1 = several days, 2= more than half the days, and 3 = nearly every day. Higher scores are indicative of higher anxiety (0-4 = minimal anxiety, 5-9= mild anxiety, 10-14 =moderate anxiety, 15-21 = severe anxiety (higher scores indicate higher level of reported anxiety).	Visit 1 Baseline (60-90 minutes), participants only complete one visit
Vestibular Ocular Motor Screening (VOMS)	Participants will complete a VOMS assessment which will take approximately 5 minutes. Prior to screening, the participant reports baseline symptoms (headache, dizziness, nausea, fogginess) on a scale from 0 to 10. Then the participant performs different eye movements that include: smooth pursuits, saccades (horizontal & vertical), convergence, vestibular ocular reflex (VOR [horizontal & vertical]), visual motor sensitivity (VMS) and again rates his/her symptoms (headache, dizziness, nausea, fogginess) on a Likert scale from 0 to 10. Abnormal findings or provocation of symptoms with any test may indicate dysfunction. This will be completed by a clinician or researcher. This procedure will be repeated after BCTT and mEXiT protocol on the same day. Higher scores indicate worse symptoms.	Visit 1 Baseline (pre and post testing 60-90 minutes), participants only complete one visit
Clinical Profiles Screening (CP-Screen)	The CP Screen is a 29 item self-report, clinical profiles based symptom inventory that measures five concussion clinical profiles: 1) anxiety/mood, 2) cognitive/fatigue, 3) migraine, 4) ocular, 5) vestibular; and two modifying factors, sleep and cervical. Patients rate the severity of their symptoms as none = 0, mild = 1, moderate = 2, or severe =3. Scores are totaled across the clinical profiles and symptom modifiers. The measure also yields a CP-Screen total raw score ranging from (0-87) with higher scores reflecting more symptoms.	Visit 1 Baseline (60-90 minutes), participants only complete one visit
Blood Pressure	Participants blood pressure will be taken same-day, before and after the BCTT or mEXiT test (both systolic and diastolic BP will be recorded with all measurements).	Visit 1 Baseline (pre and post testing 60-90 minutes), participants only complete one visit

Collaborators and Investigators

• Sponsor: University of Pittsburgh
• Investigators: Principal Investigator: Anthony P Kontos, PhD, University of Pittsburgh

Study record dates

Study Major Dates

• Study Start (Actual): March 5, 2024
• Primary Completion (Estimated): September 1, 2024
• Study Completion (Estimated): December 31, 2024

Study Registration Dates

• First Submitted: February 6, 2024
• First Submitted That Met QC Criteria: February 23, 2024
• First Posted (Actual): February 26, 2024

Study Record Updates

• Last Update Posted (Estimated): March 6, 2024
• Last Update Submitted That Met QC Criteria: March 5, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: concussion; mtbi; exertion therapy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds, Nonpenetrating; Brain Injuries; Brain Injuries, Traumatic; Brain Concussion
• Other Study ID Numbers: STUDY23070079

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Although there is no data sharing plan in place at this time, de-identified data may be shared at a later time period with other investigators.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No