Understanding racial differences in computerized neurocognitive test performance and symptom-reporting to deliver culturally competent patient-centered care for sport-related concussion

Jessica Wallace, Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA.
Erica Beidler, Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA.
Tracey Covassin, Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.
Tamaria Hibbler, Department of Athletics, Michigan State University, East Lansing, Michigan, USA.
Philip Schatz, Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania, USA.


OBJECTIVE: This study examined neurocognitive performance and symptoms between concussed Black and White collegiate athletes at baseline, post-injury, and change from baseline to post-injury. METHOD: The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) was used to measure neurocognitive performance and four concussion symptom clusters for 235 concussed collegiate athletes. Between-groups differences were documented at baseline and post-injury, along with change in scores for sex/race, and sport/race groups, using ANOVAs. Baseline scores, and days-to-post-test were covariates in post-injury comparisons. Symptom endorsement by race was evaluated using chi-square analyses. RESULTS: At baseline, group comparisons by race and sex showed that Black male/female athletes scored lower on reaction time (RT; = .008), White females scored higher on verbal memory (VerbMem; = .001), Black females scored lower on visual motor processing speed (VMS; = .001), and Black football athletes scored slower/poorer on RT ( = .001) and VMS ( = .006). Post-injury, Black males scored lower on visual memory (VisMem; .005) and VMS ( = .002), and Black football athletes scored slower on VMS ( = .005), whereas White non-football athletes scored higher on VerbMem ( = .002) and reported fewer symptoms. Significant time-by-sport/race interactions were found for VerbMem ( < .001), VisMem ( < .001) and reported symptoms. With respect to post-injury symptom scores/endorsement, Black athletes scored significantly higher for physical ( = .01) and sleep ( = .01) symptoms. CONCLUSION: These findings drive the conversation of how subjective measures of symptoms, and objective clinical concussion measures, may relate to the concussion recovery process and providing a culturally competent clinical management approach for diverse patients.