Abstract

Objective: Performance validity assessment is an important component of concussion baseline testing and Immediate Post-Concussion and Cognitive Testing (ImPACT) is the most commonly used test in this setting. A review of invalid performance on ImPACT was published in 2017, focusing largely on the default embedded validity indicator (Default EVI) provided within the test. There has since been a proliferation in research evaluating the classification accuracy of the Default EVI against independently developed, alternative ImPACT-based EVIs, necessitating an updated review. The purpose of this study was to provide an up-to-date review of the prevalence of invalid performance on ImPACT and to examine the relative effectiveness of ImPACT-based EVIs. Method: Literature related to the prevalence of invalid performance on ImPACT and the effectiveness of ImPACT-based EVIs, published between January 2000 and May 2020, was critically reviewed. Results: A total of 23 studies reported prevalence of invalid performance at baseline testing using ImPACT. Six percent of baseline assessments were found to be invalid by the ImPACT’s Default EVI, and between 22.31% and 34.99% were flagged by alternative EVIs. Six studies assessed the effectiveness of ImPACT-based EVIs, with the Default EVI correctly identifying experimental malingerers only 60% of the time. Alternative ImPACT-based EVIs identified between 73% and 100% of experimental malingerers. Conclusions: The ImPACT’s Default EVI is not sufficiently sensitive, and clinicians should consider alternative indicators when assessing invalid performance. Accordingly, the base rate of invalid performance in athletes at baseline testing is likely well above the 6% previously reported.

摘要

目标：绩效有效性评估是脑震荡基线测试的重要组成部分，脑震荡后立即和认知测试 (ImPACT) 是此设置中最常用的测试。2017 年发布了对 ImPACT 无效性能的审查，主要关注测试中提供的默认嵌入式有效性指标（默认 EVI）。从那以后，评估默认 EVI 与独立开发的替代基于 ImPACT 的 EVI 的分类准确性的研究激增，需要更新审查。本研究的目的是对 ImPACT 上无效性能的流行率进行最新审查，并检查基于 ImPACT 的 EVI 的相对有效性。方法：对 2000 年 1 月至 2020 年 5 月期间发表的与 ImPACT 上无效性能的普遍性和基于 ImPACT 的 EVI 的有效性相关的文献进行了严格审查。结果：共有 23 项研究报告了使用 ImPACT 进行的基线测试中无效性能的流行率。ImPACT 的默认 EVI 发现 6% 的基线评估无效，22.31% 至 34.99% 被替代 EVI 标记。六项研究评估了基于 ImPACT 的 EVI 的有效性，默认 EVI 只有 60% 的时间正确识别实验性装病者。基于替代 ImPACT 的 EVI 确定了 73% 到 100% 的实验性装病者。结论：ImPACT 的默认 EVI 不够敏感，临床医生在评估无效性能时应考虑替代指标。因此，运动员在基线测试中的无效成绩基准率可能远高于之前报告的 6%。