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Katherine Weise, Jennifer B. Christy, Mitchell Scheiman, Eric Borsting, Heath Hale, Sarah Dille Lee, Sarah Terry, Laura E. Dreer; Evaluation of Feasibility and Acceptability of the Convergence Insufficiency Symptom Survey for Concussion (CISS-CON) Among Concussed Youth. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5128.
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© ARVO (1962-2015); The Authors (2016-present)
The literature is rich in evidence showing that the vision system is affected in concussion; however, there is no validated instrument that allows for symptom monitoring of visually-related symptoms in concussed children. The Convergence Insufficiency Symptom Survey has been shown to be valid and reliable in children without concussion, and has been used in large-scale clinical trials. We used a survey-based cross-sectional study in a focus-group setting to evaluate the feasibility and acceptability of an adapted version of the Convergence Insufficiency Symptom Survey for use in children with concussion (“CISS-CON”).
After concussion-management professionals verbally administered the 25-item CISS-CON questionnaire to 8 children (average age = 14, SD = 2.30; 62.5% female) with history of concussion individually, each child completed a written survey containing forced-choice and open-ended questions on patient acceptability of the CISS-CON. Once individually completed, each child convened in a single, hour-long, focus group-style session (4 children per session) to verbally develop and clarify their written feedback.
On a scale ranging from 1 (none) to 10 (extreme), children did not appear to be symptomatic for headaches (M = 2.63, SD = 1.99) or dizziness (M = 1.13, SD = 1.64). The 3 minutes it took to administer the CISS-CON questionnaire was reported as “just about right” by 87.5% and “too long” in 12.5%. Most participants (75%) indicated that questions were “not too difficult to understand” and answers choices were “easy to understand” (100%). 87.5% reported that the CISS-CON did not address too many symptoms. A majority felt that the questions were comprehensive; minor edits were offered. Based on the focus group follow-up discussion, there was consensus that the CISS-CON was easy to understand, an acceptable length, did not exacerbate any concussion-like symptoms, and preferred in its current verbal professional-administered format (vs. electronic, e.g.).
Concussed pediatric patients with convergence insufficiency appear to find the CISS-CON acceptable and feasible. This instrument may be useful in both clinical care and research for professionals managing post-concussion vision symptoms in concussed children, and may have implications in return-to-learn protocols.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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