Baseline Scores and Return-to-Play Clearance: How Close to Baseline Is Close Enough?

There is no universal consensus in the concussion management community on what constitutes “recovered” in the context of baseline comparison. This ambiguity exists because the answer involves both statistical rigor and clinical judgment.

Different threshold approaches

Some clinicians require post-injury scores to return to within the reliable change index (RCI) of baseline values on all composites — meaning the difference between post-injury and baseline scores falls within the range of normal test-retest variation. Others apply a percentage threshold, such as requiring scores to return to within 90% of baseline performance. Still others use a combination: RCI criteria for the primary cognitive composites, combined with symptom resolution and balance normalization.

What the consensus says

The 6th International Consensus Statement on Concussion (2023) does not specify a numerical threshold for cognitive “recovery.” Instead, it emphasizes a multimodal, graduated return-to-play protocol where the athlete must be: symptom-free at rest, symptom-free at each progressive stage of the graduated protocol, and demonstrating functional cognitive and motor performance consistent with their pre-injury status — as determined by a qualified clinician integrating all available data.

The safest clinical approach

The safest clinical approach is conservative: require return to baseline-level performance across all tested domains (cognition, balance, vestibular-ocular function, and symptoms), combined with completion of the full graduated return-to-play protocol without symptom recurrence at any stage. The final clearance decision should be made by a healthcare provider experienced in concussion management — not by a single test score crossing a numerical threshold.

At Headquarters, we use evidence-based return-to-play criteria that integrate multi-domain baseline comparison, symptom monitoring, and graduated activity progression. Our goal is always the safest possible return — never the fastest. See our pillar guide on the return-to-play protocol.

Frequently asked questions