{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T08:24:57Z","timestamp":1773303897979,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Office of the Assistant Secretary of Defense for Health Affairs"},{"name":"Clinical and Rehabilitative Medicine Research Program"},{"name":"Psychological Health"},{"name":"Traumatic Brain Injury Research Program"},{"name":"Complex Traumatic Brain Injury Rehabilitation Research Award","award":["W81XWH-17-2-0046"],"award-info":[{"award-number":["W81XWH-17-2-0046"]}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR002489"],"award-info":[{"award-number":["UL1TR002489"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a performance-based test designed to assess active-duty service members diagnosed with mild traumatic brain injuries (mTBIs) and could potentially inform return to duty decisions. To examine the validity and responsiveness of the POWAR-TOTAL measure, this study collected self-reported and performance measures by active-duty service members before and after an episode of physical therapist care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Seventy-four individuals, enrolled in care for mTBI symptoms at 1 of 2 concussion specialty Intrepid Spirit Centers, were examined the week that they initiated physical therapy with the intention to return to active duty. Self-reported measures of concussion symptoms, pain, posttraumatic stress, headache, dizziness, and sleep quality were used, as were concurrent measures of mobility and balance. The POWAR-TOTAL task (motor and cognitive skills in single and dual-task conditions) was administered. Forty-nine active-duty service members returned for posttherapy testing using the same test battery. Effect sizes for change in measures were calculated. Construct validity was assessed by correlating change scores on POWAR with concurrent self-report and mobility measures. Responsiveness was evaluated using an anchor-based approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Significant improvements in self-reported and performance-based measures, including POWAR, were observed after therapy with moderate to large effect sizes. Improvement in POWAR performance correlated with improvement in both performance and self-reported measures. After therapy, individuals who registered improvement on the Patient Global Impression of Change scale demonstrated significantly faster POWAR motor performance than those who rated little or no improvement in their condition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The POWAR-TOTAL captured improvement on a military-specific task after completing physical therapy for mTBI and could serve as an indicator of physical recovery and readiness for return to duty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>Challenging cognitive and motor measures for service members may aid in the assessment of recovery and the ability to successfully return to duty after concussion as part of a comprehensive examination approach.<\/jats:p>\n               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Washington , USA"},{"name":"Madigan Army Medical Center, Intrepid Spirit Center , Joint Base Lewis-McChord, , Tacoma, Washington , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy S","family":"Cecchini","sequence":"additional","affiliation":[{"name":"The Geneva Foundation , Fort Liberty (Fort Bragg), , Fayetteville, North Carolina , USA"},{"name":"Womack Army Medical Center, Intrepid Spirit Center , Fort Liberty (Fort Bragg), , Fayetteville, North Carolina , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Office of Research and Scholarship , Department of Allied Health Sciences, School of Medicine, , Chapel Hill, North Carolina , USA"},{"name":"UNC\u2013Chapel Hill , Department of Allied Health Sciences, School of Medicine, , Chapel Hill, North Carolina , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney","family":"Harrison","sequence":"additional","affiliation":[{"name":"Curriculum in Human Movement Science and Division of Physical Therapy , Department of Allied Health Sciences, School of Medicine, , Chapel Hill, North Carolina , USA"},{"name":"UNC\u2013Chapel Hill , Department of Allied Health Sciences, School of Medicine, , Chapel Hill, North Carolina , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oleg","family":"Favorov","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering , School of Medicine, , Chapel Hill, North Carolina , USA"},{"name":"UNC\u2013Chapel Hill , School of Medicine, , Chapel Hill, North Carolina , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"2023111312011847800_ref1","volume-title":"DoD Worldwide Numbers for TBI, 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