Reference Values for the Headache Impact Test-6 Questionnaire.

OBJECTIVE: To determine reference values for the Headache Impact Test-6 (HIT-6) in a young, physically active cohort and to examine the influence of sex, concussion history, headache history, and competitive sport level on HIT-6 scores. DESIGN: Cross-sectional. SETTING: United States Service Academy. PARTICIPANTS: United States Service Academy cadets (N=2678) completed an HIT-6 questionnaire as part of their annual concussion baseline assessment. Cadets with a recent concussion were excluded from baseline testing. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reference values were calculated and stratified by sex, concussion history, headache history, and competitive sport level. Mann-Whitney U and Kruskal-Wallis tests were used to examine the effect of sex, concussion history, headache history, and competitive sport level on HIT-6 scores (P<.05). RESULTS: Of the 3599 cadets baselined, 2687 cadets (23% female) agreed to participate in the study and completed the HIT-6. Female participants reported significantly worse HIT-6 scores compared with male participants both with (P<.001) and without (P<.001) a concussion history. In both sexes, participants with a headache history reported worse scores than those with no headache/concussion history and a concussion history (all P<.005). Female cadets who participated in intramural athletics reported worse HIT-6 scores at baseline than female intercollegiate athletes (P=.003). CONCLUSIONS: This is the first study to stratify HIT-6 data by sex, concussion history, headache history, and sport level in a collegiate population at risk for concussions. Sex and headache history appear to influence HIT-6 scores and should be given special consideration when interpreting health-related quality of life deficits due to headache.

Single-Leg Jump Performance Before and After Exercise in Healthy and Anterior Cruciate Ligament Reconstructed Individuals.

CONTEXT: Many clinicians measure lower-extremity symmetry after anterior cruciate ligament reconstruction (ACLR); however, testing is completed in a rested state rather than postexercise. Testing postexercise may better model conditions under which injury occurs. OBJECTIVE: To compare changes in single-leg performance in healthy and individuals with history of ACLR before and after exercise. DESIGN: Repeated-measures case-control. SETTING: Laboratory. PATIENTS: Fifty-two subjects (25 control and 27 ACLR). INTERVENTION: Thirty minutes of exercise. MAIN OUTCOME MEASURES: Limb symmetry and involved limb performance (nondominant for healthy) for single-leg hop, ground contact time, and jump height during the 4-jump test. Cohen d effect sizes were calculated for all differences identified using a repeated-measures analysis of variance. RESULTS: Healthy controls hopped farther than ACLR before (d = 0.65; confidence interval [CI], 0.09 to 1.20) and after exercise (d = 0.60; CI, 0.04 to 1.15). Those with ACLR had longer ground contact time on the reconstructed limb compared with the uninvolved limb after exercise (d = 0.53; CI, -0.02 to 1.09), and the reconstructed limb had greater ground contact time compared with the healthy control limb after exercise (d = 0.38; CI, -0.21 to 0.73). ACLR were less symmetrical than healthy before (d = 0.38; CI, 0.17 to 0.93) and after exercise (d = 0.84; CI, 0.28 to 1.41), and the reconstructed limb demonstrated decreased jump height compared with the healthy control limbs before (d = 0.75; CI, 0.19 to 1.31) and after exercise (d = 0.79; CI, 0.23 to 1.36). CONCLUSIONS: ACLR became more symmetric, which may be from adaptations of the reconstructed limb after exercise. Changes in performance and symmetry may provide additional information regarding adaptations to exercise after reconstruction.

Factors Associated With Delayed Concussion Reporting by United States Service Academy Cadets.

CONTEXT: Approximately half of individuals who sustain a concussion do not immediately report their injuries. Motivators for not reporting include thinking the suspected concussion was not a serious injury and wanting to continue participating in activity. Additionally, military personnel have concerns about how concussions may affect their careers. However, delayed reporting can prolong neurobehavioral recovery. Understanding the frequency of delayed reporting and contributing factors will aid in identifying individuals who may be more likely to delay reporting. OBJECTIVE: To describe the frequency of delayed concussion reporting by service academy cadets and determine if sex, injury setting, sport level, or medical history is capable of predicting delayed reporting. DESIGN: Cohort study. SETTING: Service academies. PATIENTS OR OTHER PARTICIPANTS: A total of 316 patients with concussions were observed from January 2014 to August 2016. MAIN OUTCOME MEASURE(S): All cadets completed an annual concussion baseline collection of demographic, medical history, and sports participation information. Delayed concussion reporting served as the outcome variable. Predictor variables were sex, injury setting, and sport level, as well as concussion, headache, and learning disorder history. Frequencies were calculated to describe the proportion of participants who delayed reporting. Univariable and multivariable logistic regression models were used to assess if the predictor variables were associated with delayed concussion reporting. Odds ratios (ORs) and 95% confidence intervals were calculated for all variables included in the final model. RESULTS: Of the patients with concussion, 51% were classified as delayed reporting. In univariable models, females (OR = 1.70) and National Collegiate Athletic Association cadet-athletes (OR = 1.98) were more likely to delay reporting than males and intramural cadet-athletes, respectively. The multivariable model yielded similar findings. CONCLUSIONS: Roughly half of the cadets who sustained a concussion failed to immediately report their injury. Specifically, our data suggested that female cadets, cadets injured outside of competition, and highly competitive cadet-athletes were almost twice as likely to delay reporting as others.