Is the King–Devick Test a Reliable Tool in Wheelchair Athletes? A Preliminary Prospective Study in Wheelchair Basketball

Abstract

Objective:(1) To determine the reliability of the King–Devick (KD) test among wheelchair basketball athletes across a season and (2) to compare the KD test time changes among those with and without a clinically suspected concussion.Design:Prospective, observational study.Setting:Division 3 college athletics department.Participants:Twenty-nine intercollegiate wheelchair basketball athletes.Interventions:Athletes were prospectively monitored for concussions throughout the 2018 to 2019 season. King–Devick testing was completed preseason, midseason, postseason, and after clinically suspected concussions.Main Outcome Measures:Two-way random effects intraclass correlation coefficient (ICC) was calculated. Friedman's test and pairwise comparison with Bonferroni correction were used to compare for change over time. Mean KD times and changes were compared between athletes with and without suspected concussion.Results:The KD test demonstrated good test–retest reliability (ICC = 0.826). Among participants without a concussion, there was a significant decrease in the mean KD test time from preseason to midseason (−3.3 seconds; P = 0.0167) and preseason to postseason (−3.3 seconds; P = 0.0167). No change was seen from mid-to-post season. Six athletes had 7 suspected concussions. Each demonstrated an increase in the KD test time, with a mean increase from 44.3 ± 9.5 seconds to 53.7 ± 12.8 seconds. King–Devick test times returned to or below baseline by postseason.Conclusions:The KD test shows good reliability among wheelchair basketball athletes without a concussion. A learning effect is demonstrated initially but plateaus on subsequent testing. Unlike athletes without a concussion, players with a clinically suspected concussion showed an increase in the KD test time.

King-Devick Test in Wheelchair Sports: Identifying Normative Values and Effects of Exertion on Outcomes

“…Baseline KD scores in the current investigation were consistent with previously reported patterns for a learning effect between trial 1 and trial 2. 6,13,20,30,35 Manifestations of impairment explain the distinct KD baseline performance in the current sample (59 seconds) compared with able-bodied norms (44 seconds). Individuals with spina bifida, especially those with meningomyelocele, may have impaired motor timing, attention, cognitive and executive functioning, and working memory.…”

“…6,13,20,31 The tool has been reported to have a test-retest reliability of between 0.92 and 0.97 in able-bodied athletes 14,41 and 0.82 in collegiate wheelchair basketball athletes. 35 Empirical evidence also supports the KD to be a valid instrument in the assessment of concussion symptoms in athletic populations with greatest accuracy between 0 to 6 and 24 to 48 hours. [41][42][43]…”

“…The primary purpose of the current study was to establish normative values on the King-Devick test for contact wheelchair sport athletes. Richard et al 35 reported the mean baseline KD score to be 44.0 seconds in a small sample of collegiate wheelchair basketball players without concussion. This finding is very consistent with a meta-analysis that reported baseline KD to have a weighted average of 43.8 seconds across approximately 1400 athletes without disabilities.…”

“…Although it is clearly reported that KD values increase due to acute concussion, 6,20,30 few studies have evaluated baseline KD scores based on the concussion history. Richard et al 35 reported distinctly higher baseline KD times in collegiate wheelchair basketball players with past concussions compared with those without but in able-bodied athletes; Vartiainen et al 26 reported that there were no significant differences between baseline scores for athletes with self-reported previous concussions. Empirically, it seems that the concussion history is less likely to affect the baseline score than the impairment type.…”

“…6,30,31 Norms for these sports exist but cannot simply be extrapolated because baseline concussion scores have been distinctly worse among disability sport athletes. [32][33][34] Baseline normative KD values are emerging for this population, [35][36][37] and impairment-specific variation in cognitive processing, visual processing, and executive functioning among disability sport populations affect the KD score. 38 The primary purpose of this study was to extend normative KD baseline values for contact disability sport athletes.…”