A Fully Virtual Graded Exertion Test Is Safe and Feasible in Symptomatic and Asymptomatic Children With Concussion
Bibliographic record
Abstract
Context Current graded exertion tests (GXTs) for concussion management require specialized equipment and in-person supervision. The Montreal Virtual Exertion (MOVE) protocol is a telehealth-compatible GXT but has been tested only in pseudo-virtual conditions. Objective To determine the safety and feasibility of the MOVE protocol when administered remotely to children with concussion. Design Cohort study. Setting Virtual visit. Patients or Other Participants Asymptomatic (9 girls, 6 boys; age = 12.9 ± 2.7 years, time postconcussion = 40.8 ± 19.2 days) and symptomatic (9 girls, 6 boys; age = 12.9 ± 2.5 years, time postconcussion = 28.7 ± 23.0 days) children with concussion were recruited from the Montreal Children’s Hospital Concussion Clinic between November 2023 and June 2024. Main Outcome Measure(s) Participants completed the MOVE protocol and a follow-up visit 24 hours later over Zoom. The MOVE protocol consists of 7 plyometric exercises performed for 60 seconds with 60 seconds of rest between stages. Safety (adverse events) and feasibility measures (protocol, outcomes, intensity, and technology categories) were collected. Linear mixed models were used to evaluate exercise intensity outcomes with all other outcomes analyzed using chi-square tests. Results One participant in each group experienced a minor adverse event (symptom increase of ≥10 points on the Post-Concussion Symptom Inventory at the 24-hour visit); however, no major adverse events were reported. Mean heart rate (78.7 ± 33.6 beats/min; P < .001) and rate of perceived exertion (4.87 ± 1.50; P < .001) change scores increased throughout the MOVE protocol, but no main effect of group or interaction effect was observed. Feasibility outcomes were less likely to be captured during the rest period for asymptomatic children (outcomes not collected on time on 33 [31.4%] of 105 occasions) than symptomatic children (11 [11.7%] of 94 occasions; = 10.1, P < .001). Otherwise, all outcomes met the a priori definition of feasibility. Conclusions The MOVE protocol can be safely and feasibly administered virtually. A no-equipment, virtual GXT can remove barriers to exercise testing and broaden access to best-practice concussion-management strategies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".