The Portable Warrior Test of Tactical Agility: A Novel Functional Assessment That Discriminates Service Members Diagnosed With Concussion From Controls

Abstract

Introduction Return-to-duty (RTD) readiness assessment for service members (SM) following concussion requires complex clinical considerations. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a functional assessment which improves on previous laboratory-based RTD assessments. Methods Sixty-four SM diagnosed with concussion and 60 healthy control (HC) SM participated in this study. Group differences were analyzed to validate the POWAR-TOTAL. The High-level Mobility Assessment Test (HiMAT) was used to examine concurrent construct validity. An exploratory logistic regression analysis examined predictive validity. Results The groups were demographically well-matched except for educational level. POWAR-TOTAL measures were statistically significantly different between the groups with moderate to large effect sizes. Concussed participants were less likely to be able to complete all trials of the POWAR-TOTAL. Motor scores correlated highly with HiMAT scores. POWAR-TOTAL motor task performance and membership in the control group was significantly associated with self-reported physical readiness to deploy. Conclusion The POWAR-TOTAL is a clinically feasible, military relevant assessment that is sensitive to differences between concussed and HC SM. This analysis supports the discriminant and construct validity of the POWAR-TOTAL, and may be useful for medical providers evaluating RTD readiness for SM who have sustained a concussion.

Objective turning measures improve diagnostic accuracy and relate to real-world mobility/combat readiness in chronic mild traumatic brain injury

“…However, such tasks may not be relevant for individuals with non-combat roles, including civilian populations. While the POWAR-TOTAL established construct validity using the HiMAT (60), the present CAT results suggest that the HiMAT lacks construct validity for functional tasks for civilians. Rather than reliance on a single assessment, the continued development of multiple complementary, short, and clinically useful assessments that serve as a 'menu' based on the patient's needs may be ideal.…”

Expanding capabilities to evaluate readiness for return to duty after mTBI: The CAMP study protocol

“…This task is based on the motor and visual stability components of the POWAR-TOTAL task [ 15 ]. The run/roll task demonstrated significant differences between ADSM post-concusion and their healthy control peers, and was responsive to change after completion of physical therapy [ 15 , 16 ].…”

“…Current guidance (Department of Defense Instruction 6490.11) mandates that all SMs who have sustained a concussion be evaluated prior to RTD and stipulates that those who have persistent symptoms beyond the acute recovery phase or those who have had 3 or more concussions within a 12 month period must undergo a “functional assessment” prior to return to duty [ 11 ]. Efforts to develop measures that will meet this requirement challenge physical, sensory and cognitive skills (dual and multi-task scenarios), have proven effective in discriminating between those with concussion and their non-injured peers [ 13 , 15 , 16 ]. The Complex Assessment of Military Performance (CAMP) extends this prior work with 3 performance based tasks that target concussion vulnerabilities using sensitive physiologic measures.…”

“…The ability to process information quickly and respond appropriately, in situations where sensory information may be difficult to interpret, is important for military operations. In training and combat, the ability to quickly change positions, move while carrying a weapon, and maintain exertion while closely attending to environmental conditions are critical [ 13 , 15 , 16 ].…”

Development of a multidimensional military readiness assessment

“…Other assessments are overly specialized for a specific diagnosis or symptomology ( 7 , 8 , 15 – 19 ). For example, the Assessment of Military Multitasking Performance ( 7 , 8 , 16 – 19 ) and subsequent Portable Warrior Test of Tactical Agility ( 20 , 21 ) focus on evaluating SMs with traumatic brain injury, but are not clearly relevant and appropriate for SMs with other diagnoses such as MSK injury. There are also assessments like the Military Functional Assessment Program ( 22 , 23 ) that are highly time and resource intensive being administered over 5 days using specialized, high-tech equipment found only at large military installations, which limits feasibility for individual patient use.…”