The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit

Objective: To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury.Setting: An outpatient rehabilitation clinic.Participants: Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care.Design: A retrospective clinical audit.Main Measures: Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test. Results: Forty-nine patients (mean age: 33.7 +/- 13.0 years), on average 56.2 +/- 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 +/- 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% +/- 12.4% and reporting a rating of perceived exertion of 13.4 +/- 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 +/- 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% +/- 12.8%, P = .01) and rating of perceived exertion (17.0 +/- 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons (r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression (r = -0.41, P < .01) and late postconcussion symptoms (r = -0.40, P < .01). Conclusion: The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.