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

Context: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of postinjury motor performance, has demonstrated clinical utility but is limited by time availability and test uniformity. Objective: To assess intrasession reliability between tan-dem gait test trials and determine the number of trials necessary for optimal utility and feasibility in clinical decision-making after concussion. Design: Cross-sectional study. Setting: Pediatric sport medicine clinic. Patients or Other Participants: Adolescent athletes who recently sustained a concussion (n = 44; age = 15.4 +/- 1.8 years; 39% females) 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% females). All individuals completed 3 single-task and 3 dual-task tandem gait trials. Main Outcome Measure(s): We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and intraclass correlation coefficients (ICCs) to determine intrasession reliabil-ity. 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 groups demon-strated high intrasession reliability between tandem gait trials under single-(R > 0.82, ICC > 0.93) and dual-(R > 0.79, ICC > 0.92) task conditions. 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-groups discrimination in single-and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC < 0.67). Conclusions: Tandem gait assessments may only require 2 trials under single-task and 1 trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (ie, time requirement) of the test while maintaining excellent discriminatory ability.