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Ernst N, Schatz P, Trbovich AM, Emami K, Eagle SR, Mucha A, Collins MW, Kontos AP. J. Athl. Train. 2020; ePub(ePub): ePub.


(Copyright © 2020, National Athletic Trainers' Association (USA))






CONTEXT: Increased near point of convergence (NPC) distance is a common finding after concussion and is associated with physical symptoms and worsened neurocognitive performance. Vestibular/Ocular Motor Screening measures NPC distance across 3 trials and uses the average measurement to inform clinical care. However, whether 3 trials are necessary, are consistent, or add clinical utility is unknown.

OBJECTIVE: To investigate the consistency across 3 trials of NPC and establish the classification accuracy (ie, clinical utility) of 1 or 2 trials compared with the standardized average of 3 trials.

DESIGN: Retrospective cohort study.

SETTING: Sports medicine clinic and research laboratory.

PATIENTS OR OTHER PARTICIPANTS: Consecutively enrolled patients aged 10 to 22 years with diagnosed concussions (74% sport related; n = 380).

MAIN OUTCOME MEASURE(S): The previously reported clinical cutoff value of ≥5 cm across 3 trials was used. Pearson correlation and intraclass correlation coefficients were used to evaluate agreement between trials and average scores. Reliable change indices (RCIs) using 95% confidence intervals were also calculated.

RESULTS: The Pearson correlation (r =.98) and intraclass correlation (0.98) coefficients revealed excellent agreement between the first measurement and average NPC distance across 3 measurements. The RCI across all trials was 2 cm. When the first NPC measurement was ≤3 cm or ≥7 cm, agreement existed within the RCI between the first measurement and the average of 3 measurements in 99.6% of cases. When we averaged the first and second measurements, 379/380 (99.7%) participants had the same classification (ie, <5 cm = normal, ≥5 cm = abnormal) as the average NPC distance across 3 measurements.

CONCLUSIONS: Our findings suggest limited utility of multiple or average NPC distance measurements when the initial NPC distance is outside of RCI clinical cutoffs (ie, ≤3 cm or ≥7 cm). Given the high consistency between the first measurement and average NPC distance across 3 trials, only 1 measurement of NPC distance is warranted unless the first measurement is between 3 and 7 cm.

Language: en


mild traumatic brain injury; convergence; Ocular Motor Screening (VOMS); Vestibular


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