Reliability and Validity of the Functional Assessment of Neurocognition in Sport: A Paradigm Shift in Postconcussion Return-to-Sport Decision-Making
Year: 2025
Type: article
Abstract: Context Assessments used after concussion provide strong diagnostic accuracy and aid in initial health care planning, but they can have limited utility after the acute time frame. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS), to address these limitations. Objective To evaluate the psychometric properties of the FANS, including test-retest reliability, minimal detectable change, and divergent validity. Design Descriptive laboratory study. Setting Clinical laboratory. Patients or Other Participants A total of 17 healthy, physically active participants (10 [58.82%] women, 7 [41.18%] men; age = 21.94 ± 3.15 years, height = 170.49 ± 11.42 cm, mass = 72.99 ± 26.72 kg; 13 [76.5%] with no lifetime concussion history). Main Outcome Measure(s) Participants completed the FANS at 2 time points approximately 14 days apart and conventional clinical assessments (symptom checklist, balance testing, and computerized neurocognitive testing) at the first time point. We used the FANS to examine 7 cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, and delayed visual memory) by incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients with 95% CIs and Pearson r correlations to evaluate test-retest reliability and divergent validity. Results All FANS outcomes displayed acceptable test-retest reliability (intraclass correlation coefficient ≥ 0.63), with the lowest being the verbal memory interference subtest. Standard error of measurement and minimal detectable change values overall were small relative to their possible score ranges. Correlations between the FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeded the divergent validity threshold with computerized neurocognitive testing reaction time ( r range, −0.79 to 0.77). Conclusions The FANS overall displayed acceptable test-retest reliability comparable with traditional neurocognitive test platforms and acceptable divergent validity. The FANS reaction time and processing speed may overlap partially with computerized neurocognitive testing reaction time, and this warrants further examination in a clinical population. Although the FANS is reliable and valid for use, future research is needed to establish the utility of the FANS for return-to-sport readiness for concussion.
Source: Journal of Athletic Training
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411420012