Objective Assess the validity of an app-based assessment of the functional impact of concussion symptoms compared to traditional scales.

Design Prospective cohort study.

Setting Multi-disciplinary pediatric concussion clinic in the Midwestern United States.

Participants 27 pediatric mTBI patients enrolled at first clinic visit post-injury. Exclusions: moderate or severe TBI, brain surgery, substance abuse, major psychiatric disorder, or special education.

Interventions Patients completed SCAT3, Post-Concussion Symptom Scale, and FACT app at enrollment. FACT app was completed daily for 21 days, then every three days until recovery; additional assessments were completed at clinic visits.

Outcome Measures Functional impact of symptoms was measured on the app with symptoms divided into four domains; symptoms were selected, and then impact on functioning using a stoplight scale was selected for each domain. Simple and multiple linear regression models and proportional hazards models measured the predictive value of FACT and domain scores.

Main Results The total FACT symptom score (p<0.03) and FACT rating score (p<0.01) were predictive of total SCAT and PCSS scores. The FACT rating score in ‘mood’ and ‘thinking and remembering’ domains (p<0.02) were also predictive of SCAT and PCSS scores. Gender was the only significant predictor of recovery and data did not support FACT or PCSS scores as predictors of recovery in adjusted gender models.

Conclusions Initial data supports the construct validity and indicates that FACT measures a different component of the recovery experience. Shifting assessment from symptom severity to functional impact mitigates bias from baseline symptoms. FACT version 2 is now being studied.