RESUMEN
BACKGROUND: Concussion management practices are important for athlete safety. Baseline testing provides a benchmark to which post-injury assessments are compared. Yet few neurophysical concussion assessment studies have examined learned response. The Balance Error Scoring System (BESS) measures postural stability through 6 conditions by counting the errors committed during each condition. In a study examining the performance of high school-aged athletes on the BESS, the learned response extinguished in 3 weeks. However, this phenomenon has not been studied in the college-aged population. HYPOTHESIS: College-aged adults performing the BESS will have a learned response at 1 and 2 weeks but would have no change from baseline at or after 3 weeks, as found previously in high school-aged subjects. STUDY DESIGN: Randomized controlled clinical trial. METHODS: Three groups of college-aged adults ages 18 to 26 years were tested using the BESS at scheduled intervals. Each subject was randomly assigned into 1 of 3 groups to determine learned response at weeks 1, 2, and 4. Changes in pretest and posttest BESS scores were compared using the paired t test for each group at week 4 and other intervals. Differences among groups were compared using analysis of variance for means or the chi-square test for proportions. RESULTS: After 4 weeks, participants exhibited a mean (95% confidence interval) change from pretest baseline of -2.30 (-4.75, 0.16) in the control group (P = 0.065), -3.13 (-4.84, -1.41) in Group 1 (P = 0.001), and -2.57 (-5.28, 0.15) in Group 2 (P = 0.063). There were no statistically significant differences between the 3 groups for week 4 BESS score (P = 0.291) or changes from baseline to week 4 BESS scores (P = 0.868). Overall, participant score changes from baseline to the 4-week follow-up still showed a statistically significant or close to significant reduction across the 3 groups, indicating the learned response did not extinguish after 4 weeks. CONCLUSION: Repeated BESS testing results in a learned effect in college-aged adults did not extinguish after 4 weeks. These results question the ability of the BESS to assess an athlete's balance deficits following a concussion. CLINICAL RELEVANCE: Given learned response did not extinguish in this sample and the BESS has a minimal detectable change/reliable change index of 7 or greater, the effectiveness of the BESS to assess balance may be limited.
RESUMEN
INTRODUCTION: The prevalence of chronic disease in the US population is increasing. Projections indicate that half the US population will live with at least one chronic disease by the year 2030. Statistics indicate that chronic illnesses account for 70% of all deaths. Developing healthy self-management behaviors can lower the risk of developing chronic disease and also minimize the magnitude of subsequent morbidity and disability. Individuals need access to reliable information in order to learn successful self-management skills. Delivering healthcare information in rural areas is difficult. Geography, distance, inclement weather and/or the lack of financial resources are barriers that can prevent individuals from accessing health care and health education. Likewise, rural health clinics often lack the financial resources to provide the most current patient education materials. However, the internet allows remote and immediate access to this type of information if individuals know how and where to search for it. An internet portal, My Health Education & Resources Online (MyHERO) was created to facilitate locating current, non-commercial, reliable, evidence-based health information. The authors sought to assess the impact of a publically accessible internet information portal on diabetes knowledge, quality of life (QOL) measures, and self-management behaviors in a US rural area. METHODS: Participants (n=48) with type 2 diabetes in one clinic received regularly scheduled, one-on-one individualized diabetes-related health education and hands-on instructions on how to use an internet portal from a nurse educator. Each health clinic was supplied with a laptop computer for participants to use if they lacked internet access. Control participants (n=50) in a second clinic received a pamphlet describing how to access the portal. All participants completed baseline and end-of-study surveys. Disease knowledge was measured with the BASICS test developed by the International Diabetes Center. Problem Areas In Diabetes (PAID), developed by the Joslin Diabetes Center, was utilized to measure diabetes QOL. All participants completed a behavior modification survey at the conclusion of the study. Intervention participants were asked to complete a satisfaction survey at the conclusion of the study. Demographic and relevant laboratory values (eg serum glucose, HbA1c, lipids) were collected via chart review at baseline, 3, and 6 months. RESULTS: Demographic and baseline scores were similar between groups. At 6 months, the intervention group showed significant increases in disease knowledge and self-blood glucose monitoring behavior. There were no differences in QOL between the groups at 6 months. Participants in the intervention group were highly satisfied with the nurse educator, but not with the internet as a resource. CONCLUSION: Disease knowledge and self-blood glucose monitoring improved with one-on-one education. High attrition and a short study period were limitations of this study. The researchers speculate that the age of the participants and low internet penetration affected satisfaction scores. Future recommendations include a longer data collection period, more widespread publically accessible internet kiosks (grocery stores, malls, churches etc), other chronic disease states, and younger participants.