Clinical Feasibility and Utility of a Dual-Task Tandem Gait Protocol for Pediatric Concussion Management

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Abstract
Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. Design: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. Outcome Measures: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Results: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Conclusion: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

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