{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:59:50Z","timestamp":1790873990475,"version":"4.1.0"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010652","name":"Holland Bloorview Kids Rehabilitation Hospital Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100010652","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Holland Family Professorship in Acquired Brain Injury","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Bloorview Children\u00e2\u20ac\u2122s Hospital Foundation Chair in Pediatric Rehabilitation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100020895","name":"Temerty Faculty of Medicine, University of Toronto","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100020895","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ontario Graduate Scholarship","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>Return-to-play (RtoP) clearance after concussion typically involves single- and dual-task assessments that do not reflect the speed or complexity of sport. We developed <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic>, a dynamic multi-domain assessment tool for concussion. This study aimed to (1) demonstrate proof of concept for <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> by evaluating alignment with design objectives (easy to use, fun, sport-like, clinically valuable, resource efficient, and flexible); and (2) document subsequent iterations to <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> design. A multi-method evaluation was performed wherein clinicians were paired with youth to test <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> together and complete separate semi-structured interviews. Quantitative metrics included the System Usability Scale (SUS), heart rate (HR), ratings of perceived exertion (RPE), assessment durations, and <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> completion times, errors, and multi-task cost scores (changes in performance with the introduction of new challenges). Interviews explored perspectives on design objectives, analyzed using content analysis. Participants included five clinicians (n\u2009=\u20092 occupational therapy; n\u2009=\u20091 physiotherapy; n\u2009=\u20091 athletic therapy; n\u2009=\u20091 medicine) and 10 youth (ages 10\u201322 years). Assessments took 30\u201340 minutes despite minor technical challenges (e.g., unresponsive equipment). Clinician-rated usability was good-to-excellent (SUS\u2009=\u200981\u2009\u00b1\u20098.4; 95% CI: 73.6, 88.4) and youth reported that instructions were easy to follow. Moderate-to-high-intensity exertion was achieved (peak HR\u2009=\u200980\u2009\u00b1\u200911% age-predicted maximal; 95% CI: 77.4%, 88.5%). Multi-task cost scores reflected some aspects of hypothesized level demand loading. Clinicians described <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> as potentially valuable to assess sport tolerance and enable rich observations of multi-domain skill integration. Tables were constructed to map study findings onto design iterations. This study supports proof-of-concept for <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic>, a new multi-domain concussion assessment tool, and identified areas for improvement, which has informed changes to the design of <jats:italic><jats:italic>R2Play<\/jats:italic><\/jats:italic> before broader evaluation among youth post-concussion.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001049","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:32:27Z","timestamp":1760463147000},"page":"e0001049","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Multi-method proof-of-concept evaluation for R2Play: a novel multi-domain return-to-play assessment tool for concussion"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-2173","authenticated-orcid":true,"given":"Josh","family":"Shore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavreet","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"DuPlessis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lovell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Hickling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanny","family":"Hotz\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Biddiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon E.","family":"Scratch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"1","key":"pdig.0001049.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.csm.2020.08.013","article-title":"Epidemiology of Sport-Related Concussion","volume":"40","author":"LA Pierpoint","year":"2021","journal-title":"Clin Sports Med"},{"issue":"5","key":"pdig.0001049.ref002","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1136\/bjsports-2015-094978","article-title":"The incidence of concussion in youth sports: a systematic review and meta-analysis","volume":"50","author":"T Pfister","year":"2016","journal-title":"Br J Sports Med"},{"issue":"11","key":"pdig.0001049.ref003","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/bjsports-2023-106898","article-title":"Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022","volume":"57","author":"JS Patricios","year":"2023","journal-title":"Br J Sports Med"},{"issue":"1","key":"pdig.0001049.ref004","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s10439-011-0413-3","article-title":"A review of return to play issues and sports-related concussion","volume":"40","author":"AW Doolan","year":"2012","journal-title":"Ann Biomed Eng"},{"key":"pdig.0001049.ref005","unstructured":"Carson D, DipSportMed CCFP, Diep D, Baker C, Kraft SA, Kuwahara N, et al. 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