The Development and Reliability of Four Clinical Neurocognitive Single-leg Hop Tests: Implications for Return to Activity Decision Making.

CONTEXT:: Functional tests are limited primarily by measuring only physical performance. However, athletes often multitask, and deal with complex visual-spatial processing while being engaged in physical activity.

OBJECTIVE:: Present the development and reliability of four new neurocognitive single-leg hop tests that provide more ecological validity to test sport activity demands than previous functional return to sport testing.

DESIGN:: Cross-sectional.

SETTING:: Gymnasium.

PARTICIPANTS:: Twenty-two healthy participants (9 Male, 13 Female, 20.9±2.5 years, 171.2±11.7 cm, 70.3±11.0 kg) were recruited.

INTERVENTIONS:: Maximum distance (physical performance) and reaction time (cognitive performance) were measured for three of the neurocognitive hop tests all testing a different aspect of neurocognition (single-leg central-reaction hop - reaction time to one central stimulus, single-leg peripheral-reaction crossover hop - reaction time between two peripheral stimuli, and single-leg memory triple hop - reaction to memorized stimulus with distractor stimuli). Fastest time (physical performance) and reaction time (cognitive performance) was measured for the fourth neurocognitive hop test (single-leg pursuit 6m hop - requiring visual field tracking (pursuit) and spatial navigation).

MAIN OUTCOME MEASURES:: Intraclass correlation coefficients (ICCs) were calculated to assess reliability of the four new hop tests. Additionally, Bland-Altman plots and one-sample t-tests were conducted for each single-leg neurocognitive hop to evaluate any systematic changes.

RESULTS:: ICCs based on day one and day two scores ranged from 0.87-0.98 for both legs for physical and cognitive performance. The Bland-Altman plots and one-sample t-tests (p>0.05) indicated that all four single-leg neurocognitive hop tests did not change systematically.

CONCLUSION:: These data provide evidence that a neurocognitive component can be added to the traditional single-leg hop tests to provide a more ecologically valid test that incorporates the integration of physical and cognitive function for return to sport. The test-retest reliability of the four new neurocognitive hop tests is highly reliable and does not change systematically.