Can the Buffalo Concussion Treadmill Test Be Used As a Prognostic Indicator for Patients with Sport-Related Mild Traumatic Brain Injury?

OBJECTIVE:To establish whether time to exercise cessation using the Buffalo Concussion Treadmill Test (BCTT) protocol can be used as a prognostic indicator of recovery after sport-related mild traumatic brain injury (SR-mTBI).DESIGN:Retrospective analysis of prospectively collected data.SETTING:Specialist Concussion Clinic.PARTICIPANTS:Three hundred and twenty one patients presenting between 2017 and 2019 who underwent BCTT for SR-mTBI.INTERVENTIONS:Participants who remained symptomatic at a 2-week follow-up appointment after SR-mTBI underwent BCTT to develop a progressive subsymptom threshold exercise program with fortnightly follow-up until clinical recovery.MAIN OUTCOME MEASURES:Clinical recovery was the primary outcome measure.RESULTS:A total of 321 participants were eligible to participate in this study (mean age 22.94% and 46% female). The BCTT test duration was divided into 4-minute intervals and those who completed full 20 minutes. There was higher probability of clinical recovery in those who finished the entire 20-minute BCTT protocol compared with those who managed 17-<20 minutes (Hazard Ratio, HR 0.57), 13 to 16 minutes (HR 0.53), 9 to 12 minutes (HR 0.6), 5 to 8 minutes (HR 0.4), and 1 to 4 minutes (HR 0.7), respectively. Those seen earlier after injury ( P = 0.009), male patients ( P = 0.116), younger patients ( P = 0.0003), and those with physiological or cervical dominant ( P = 0.416) symptom clusters were more likely to achieve clinical recovery. Fifty percent of those who completed the full BCTT protocol achieved clinical recovery at day 19 post-injury.CONCLUSIONS:The group completing full 20 minutes of BCTT achieved clinical recovery more quickly than those who did not complete full BCTT.