Article Title



Dave P. Heller1, Kelsi Rempe1,2 & Brittany Oppland1. 1Rockhurst University, Kansas City, MO;2Des Moines University, Des Moines, IA; e-mail: dave.heller@rockhurst.edu

The Balance Error Scoring System (BESS) is a common field assessment used by athletic trainers to determine the severity of a concussion sustained during participation in sports. BESS is facilitated by a trained practitioner and, as such, is subjective. As with many subjective measures, BESS has been shown to suffer from inter-and intra-rater reliability issues, as well as exhibiting a learning effect. Data taken for a related study indicates that results from balance assessments similar to BESS may also exhibit a gender effect. PURPOSE: The purpose of this study was to investigate the effect of gender on balance tasks similar to those performed during BESS. METHODS: 36 participants (27 females and 9 males) were recruited for a related study investigating balance deficits in concussed participants (6 females, 6 males) compared to controls (21 females, 3 males). Participants attempted to maintain balance in quiet stance for twenty seconds in five of the six BESS conditions, excluding the single-leg stance on foam. Outcome measures included the number of times a participant did not maintain stability while performing a trial of a particular task (“trial failures”). Additionally, if a participant failed to maintain stability during three trials under the same task conditions, the instability for that particular task (“task failures”) was recorded. RESULTS: A two-way ANOVA showed no significant interaction effect between gender and concussion status, nor was there any main effect for concussion status for either outcome measure. There was a statistically significant main effect for gender in both the total number of trial failures per participant (Female: 3.512 + 0.468 vs. Male: 1.667 + 0.715, F3,32 = 4.667, p = 0.038) as well as the number of BESS-task failures per participant (Female: 0.821 + 0.158 vs. Male: 0.083 + 0.241, F3,32 = 6.550, p = 0.015). CONCLUSION: Care must be taken when using BESS in determining the severity of concussion symptoms or when returning an athlete to competition. Due to a possible gender effect, females could present with a higher score and therefore be misdiagnosed with a more severe concussion or held out of competition longer than their male counterparts.

Funding provided by a Dean’s Undergraduate Fellowship Grant from Rockhurst University.

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