Feasibility of Physical Therapy Evaluation Symptom Provocation Tests in Older Adults With Mild Traumatic Brain Injury: Mixed Methods Study.

Background: Early standard assessment protocols have decreased costs and better identified treatment strategies in individuals with mild traumatic brain injury (mTBI). Clinical practice guidelines contained strong recommendations for the use of provocation tests in evaluating younger adults (<65 y of age). Currently, the recommended protocols and literature regarding tolerance to self-reported and physical exertion outcome testing in older adults (>65 y of age) with mTBI have been limited. To start bridging some of these shortcomings and aid the development of practice guidelines for older adults, this study explored the feasibility of physical therapy evaluation protocols for individuals aged >65 years. Objective: The study aimed to (1) assess the feasibility and tolerance of using evidence-based physical therapy evaluation outcome tests, and (2) apply the International Classification of Health, Disability, and Function (ICF) domains to an emergent thematic analysis of research protocols involving older adults with and without mTBI. Methods: The feasibility study was a mixed methods design that included 13 community participants (>65 y) with and without mTBI. Investigators documented completion of the health form, participant-reported outcomes including the Patient-Specific Function Scale (PSFS) and Post Concussion Symptom Scale, and physical performance measures using the Motion Sensitivity Quotient (MSQ) and a submaximal recumbent stepper test, modified from the Buffalo Concussion Bike Test. Emergent contextual themes were identified within the study protocol, testing space, and participant responses. Results: The sample included 13 participants (aged 65-91 y; 7 females, 6 males), 4 with mTBI and 9 without mTBI. All completed the health form, PSFS, and Post Concussion Symptom Scale, with moderate verbal cues required in 15% (PSFS) of the cases. The Motion Sensitivity Quotient and Buffalo Concussion Bike Test-Modified were completed to the participants' maximum safe effort. No participants experienced adverse mTBI symptoms. The categories for the theme of study protocol were time, communication, and logistics coordination. The categories for the theme of study environment were assessment, documentation, and safety. Unanticipated positive emotions were evoked with comments such as feedback, including participation was "fun" and "I didn't know I could do all this." Conclusions: Older adults were able to tolerate the collection of participant-reported and physical outcome measures that allowed for individual maximal safe efforts without mTBI symptom provocation. The contextual themes using the ICF model of study protocol and environment were categorized and coded for future research consideration. Positive emotion participant responses were captured at the end of data collection. Clinical Relevance: This study applied standard physical therapy assessment protocols, which were safely tolerated by older adults with mTBI. The study used ICF domains from a research procedure perspective for protocol and environment considerations. The findings included participants' positive emoted responses, which may inform future large-sample trials in the evaluation of older adults with mTBI.