Remotely Assessing Motor Function and Activity of the Upper Extremity After Stroke: A Systematic Review of Validity and Clinical Utility of Tele-Assessments.

OBJECTIVE: The aim of this systematic review is to identify currently available tele-assessments for motor impairments of the upper extremity in adults after a stroke and to assess their psychometric properties and clinical utility. DATA SOURCES: We searched for studies describing the psychometric properties of tele-assessments for the motor function of the upper extremity. A systematic search was conducted in the Cumulative Index to Nursing and Allied Health Literature, Medline via OVID, Embase, The Cochrane Library, Scopus, Web of Science and Institute of Electrical and Electronics Engineers Xplore from inception until 30 April 2024. REVIEW METHODS: The quality assessment for the included studies and the rating of the psychometric properties were performed using the COSMIN Risk of Bias Checklist for systematic reviews of patient-reported outcome measures. RESULTS: A total of 12 studies (N = 3912) describing 11 tele-assessments met the predefined inclusion criteria. The included assessments were heterogeneous in terms of quality and psychometric properties and risk of bias. None of the tele-assessments currently meets the criteria of clinical utility to be recommended for clinical practice without restriction. CONCLUSION: The quality and clinical utility of tele-assessments varied widely, suggesting a cautious consideration for immediate clinical practice application. There is potential for tele-assessments in clinical practice, but the clinical benefits need to be improved by simplifying the complexity of tele-assessments. REGISTRATION NUMBER: CRD42022335035.

Spinal Cord Injuries in Iraq: A Teleassessment Survey of the Survivors from 2017 to 2018 Islamic State of Iraq and Syria War.

Introduction: The significance of comprehensive investigations specifically addressing the characteristics and implications of nervous system injuries (NSIs) and particularly war-related spinal cord injuries (SCI) remain limited. Iraq lacks comprehensive survey studies for quality of life for people after SCI. The objective of this work was to identify the number of NSIs and mortality of those injured during the Islamic State of Iraq and Syria (ISIS) war in Iraq and analyze events specifically as sociodemographic variables to assess quality of life healthy, psychological, and social disorders from onset of injury till the involving. Methods: A survey-based descriptive study, and analytical retrospective at community-based of Nineveh Governorate, in Iraq. The participants were 34 survivors of ISIS war with SCIs, ages between 9 and 60 years, and 7 females (20.59%) and 27 males (79.41%) as registered in Nineveh Center of Disability Rehabilitation. Data collection was conducted using Telephone Video Interviews and respondents' health information. Protocol-specific questions and some psychological and social scales (PTSD) (DSM-IV), (TAS-20), (SWLS), and (MSPSS) were also used. Results: There were 2,990 NSIs with the highest rate of injuries occurring from 2017 to 2018, and the SCIs were 267 injuries (8.93%), and (70.59%) at level T the mortalities were 57 cases, all participants suffered from physical and psychological chronic complications, while the results of the PTSD, GPC, and SWLS were at a moderate level. Conclusions: In urban warfare, there's a rise in NSIs, notably SCIs influenced by the type of weaponry. The survivors face significant physical, psychological, social, and financial burdens. More research is crucial to understanding their situations and developing strategies to alleviate their health, social, and financial challenges.

Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements.

A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 ± 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6MWT) and twice outside each patient's home via a web-based platform TL 6MWT. The study showed a high statistically significant correlation between the CB and TL 6MWT (Pearson's r = 0.76, p < 0.001). Reliability testing showed no statistically significant differences in the distance covered (CB1: 492 ± 84 m and CB2: 506 ± 86 m versus TL1: 534 ± 87 m and TL2: 542 ± 93 m, respectively) and in the best distance of the TL 6MWT (545 ± 93 m) compared to the best CB distance (521 ± 83 m). Strong internal reliability for both the CB (intraclass correlation coefficient (ICC) = 0.93) and the TL 6MWT (ICC = 0.98) was found. The results indicate that a TL 6MWT performed outdoors can be a highly valid and reliable tool to assess functional capacity in patients with DM2. No learning effect between the TL and CB assessment was found, minimizing the need for repetition.

Determining Post-COVID-19 Symptoms and Rehabilitation Needs in Hospitalized and Nonhospitalized COVID-19 Survivors with Tele-Assessment Methods.

Objectives: This study aimed to evaluate the post-COVID-19 symptoms, the severity of symptoms, and functional capacities seen in hospitalized and nonhospitalized COVID-19 survivors according to time periods (total 6, 1-3, and 3-6 months) by tele-assessment methods and to predict the need for periodic rehabilitation of COVID-19 survivors. Methods: Three hundred ninety-four COVID-19 survivors (50.18 ± 15.14 years) who were between 1 and 6 months after PCR(+) were included in the study, and their ongoing symptoms and the severity of these symptoms (0-10 points) were assessed with COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) Tool, and the 30-s Chair Stand Test (CST) was applied by tele-assessment methods. Results: In hospitalized and nonhospitalized survivors of COVID-19, 87% experienced at least one symptom within the first 6 months. The most prevalent symptoms were anxiety (47.7%), fatigue (46.7%), and muscle pain (45.7%). The most common symptom in the nonhospitalized group was fatigue (52.6%), whereas anxiety was 46.8% in the hospitalized group. The 30-s CST score of the nonhospitalized group was significantly higher than the hospitalized group (p < 0.001). Conclusions: In the first 6 months post-COVID-19, musculoskeletal problems, anxiety, fatigue, and muscle pain were observed to be the most prevalent symptoms, regardless of time, in hospitalized and nonhospitalized survivors. There was a serious decrease in their functional capacity. Priority should be given to psychiatric, cardiopulmonary, and musculoskeletal rehabilitation in post-COVID-19. Inclusion of hospitalized/nonhospitalized COVID-19 survivors in a comprehensive rehabilitation program tailored to their needs by following a comprehensive tele-assessment by a multidisciplinary team will reduce the "long COVID-19 syndrome." ClinicalTrials.gov Registration Number: NCT04900441.

Tele-Assessment of Oral Personal Narratives in Arabic- and Hebrew-Speaking Children Using the Global TALES Protocol.

INTRODUCTION: Tele-assessment (TA) has the potential to enhance access to speech therapy. This preliminary study aimed to investigate the impact of assessment mode (face-to-face [FTF] vs. TA) on the microstructure level and chosen topics of personal narratives produced by Arabic-speaking and Hebrew-speaking school-age children living in Israel. We also investigated whether performance variations, if evident, could be attributed to the children's language/culture. METHODS: Eighty-nine 10-year-old children, 38 Arabic-speaking and 51 Hebrew-speaking, living in Israel, participated in this study. Forty participants were assigned to a TA group (via Zoom) and 49 to a FTF group. All participants were assessed using the Global TALES protocol, generating six personal narratives each. The narratives were analyzed regarding the following microstructural measures: total number of words, total number of utterances (TNU), number of different words, and mean length of utterance in words (MLU-W). Additionally, each narrative was categorized into a topic according to the Global TALES protocol. RESULTS: The analysis revealed no significant main effect of assessment mode on any of the microstructure measures. However, a significant interaction effect between language/culture and assessment mode was found for TNU and MLU-W, with a significant main effect for TNU exclusively in the Arabic narratives, with the Arabic-speaking children producing more utterances through FTF compared to TA. Across language/culture groups, there was a significant effect of assessment mode on the chosen topic. Additionally, there were significantly higher scores in the Hebrew compared to the Arabic narratives in all microstructure measures, and language/culture also influenced the chosen topics. CONCLUSIONS: The results support the feasibility of TA mode for assessing personal narratives in school-aged children, using the Global TALES protocol. However, the results also suggest that TA results may be affected by the language/culture of the narrator. Finally, the findings highlight the potential influence of TA on the chosen topics of personal narratives, perhaps due to a decrease in the quality of communication in TA.

Intra- and Inter-Rater Reproducibility of the Face-to-Face and Tele-Assessment of Timed-up and Go and 5-Times Sit-to-Stand Tests in Patients with Chronic Obstructive Pulmonary Disease.

Timed-Up and Go (TUG) and 5-Times Sit-to-Stand (5STS) are frequently used in clinical practice for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the intra- and inter-rater reproducibility of the TUG and 5STS as both face-to-face and tele-assessment tests in patients with COPD. Forty-four patients with diagnosed COPD were included. Evaluations were carried out face-to-face and tele-assessment (synchronized and asynchronized). Inter-reliability between face-to-face and tele-assessment was excellent for TUG (ICC = 0.977) and 5STS (ICC = 0.970). Inter-reliability between two tele-raters was also excellent for TUG (ICC = 0.995) with the SEM = 0.04, SEM95% = 0.08, and SDC95% = 0.10 s, and 5STS (ICC = 0.990) with the SEM = 0.06, SEM95% = 0.12, and SDC95% = 0.18 s. Intra-rater reliability of the tele-assessment (synchronized) was excellent for TUG (ICC = 0.976) and 5STS (ICC = 0.964). The SEM, SEM95%, and SDC95% values were computed as 0.08, 0.16, and 0.22 s for TUG, and 0.11, 0.22, and 0.31 s for 5STS, respectively. The TUG and 5STS tests are reproducible tele-assessment measures in patients with COPD with excellent intra- and inter-rater reproducibility. The authors recommend these tests as practical assessment tools in patients with COPD at home for tele-health interventions. The reported SEM, SEM95%, and SDC95% values can be used as a minimum change that needs to be observed to be confident that the observed change is real and not, potentially, a product of measurement error.

Validity and Reliability of a Novel Smartphone Tele-Assessment Solution for Quantifying Hip Range of Motion.

BACKGROUND: Tele-health has become a major mode of delivery in patient care, with increasing interest in the use of tele-platforms for remote patient assessment. The use of smartphone technology to measure hip range of motion has been reported previously, with good to excellent validity and reliability. However, these smartphone applications did not provide real-time tele-assessment functionality. We developed a novel smartphone application, the TelePhysio app, which allows the clinician to remotely connect to the patient's device and measure their hip range of motion in real time. The aim of this study was to investigate the concurrent validity and between-sessions reliability of the TelePhysio app. In addition, the study investigated the concurrent validity, between-sessions, and inter-rater reliability of a second tele-assessment approach using video analysis. METHODS: Fifteen participants (nfemales = 6) were assessed in our laboratory (session 1) and at their home (session 2). We assessed maximum voluntary active hip flexion in supine and hip internal and external rotation, in both prone and sitting positions. TelePhysio and video analysis were validated against the laboratory's 3-dimensional motion capture system in session 1, and evaluated for between-sessions reliability in session 2. Video analysis inter-rater reliability was assessed by comparing the analysis of two raters in session 2. RESULTS: The TelePhysio app demonstrated high concurrent validity against the 3D motion capture system (ICCs 0.63-0.83) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.48, p = 0.99). The video analysis demonstrated almost perfect concurrent validity against the 3D motion capture system (ICCs 0.85-0.94) for all hip movements in all positions, with the exception of hip internal rotation in prone (ICC = 0.44, p = 0.01). The TelePhysio and video analysis demonstrated good between-sessions reliability for hip external rotation and hip flexion, ICC 0.64 and 0.62, respectively. The between-sessions reliability of hip internal and external rotation for both TelePhysio and video analysis was fair (ICCs 0.36-0.63). Inter-rater reliability ICCs for the video analysis were 0.59 for hip flexion and 0.87-0.95 for the hip rotation range. CONCLUSIONS: Both tele-assessment approaches, using either a smartphone application or video analysis, demonstrate good to excellent concurrent validity, and moderate to substantial between-sessions reliability in measuring hip rotation and flexion range of motion, but less in internal hip rotation in the prone position. Thus, it is recommended that the seated position be used when assessing hip internal rotation. The use of a smartphone to remotely assess hip range of motion is an appropriate, effective, and low-cost alternative to the face-to-face assessments. This method provides a simple, cost effective, and accessible patient assessment tool with no additional cost. This study validates the use of smartphone technology as a tele-assessment tool for remote hip range of motion assessment.

Testing Our Children When the World Shuts Down: Analyzing Recommendations for Adapted Tele-Assessment during COVID-19.

In 2017, the National Association of School Psychologists described tele-assessment as the least researched area of telehealth. This became problematic in 2020 when COVID-19 curtailed the administration of face-to-face assessments. Publishers began to offer computer-adapted tele-assessment methods for tests that had only previously been administered in person. Recommendations for adapted tele-assessment practice had to be developed with little empirical data. The current study analyzed recommendations from entities including professional organizations, test publishers, and governmental offices. The samples for each were small, but the findings were noteworthy. Test publishers were unanimous in recommending the use of their face-to-face assessments through adapted tele-assessment methods (either with or without caution). Governmental agencies were more likely to recommend not using adapted tele-assessment methods or to use these methods with caution. Finally, professional organizations were almost unanimous in their recommendations to use adapted tele-assessment but to do so with caution. In addition to deviations in the types of recommendations provided, entities varied in how the information was distributed. About one-fifth (23.5%) of all entities surveyed provided no recommendations at all. About 45% of the remaining entities provided recommendations on their Web sites. The rest provided information through shared documents, online toolkits, peer-reviewed journals, and emails. Implications for the field of psychology's future crisis management planning are discussed in response to these findings.

Design and Construction of a Bilateral Haptic System for the Remote Assessment of the Stiffness and Range of Motion of the Hand.

The use of haptic devices in the rehabilitation of impaired limbs has become rather popular, given the proven effectiveness in promoting recovery. In a standard framework, such devices are used in rehabilitation centers, where patients interact with virtual tasks, presented on a screen. To track their sessions, kinematic/dynamic parameters or performance scores are recorded. However, as Internet access is now available at almost every home and in order to reduce the hospitalization time of the patient, the idea of doing rehabilitation at home is gaining wide consent. Medical care programs can be synchronized with the home rehabilitation device; patient data can be sent to the central server that could redirect to the therapist laptop (tele-healthcare). The controversial issue is that the recorded data do not actually represent the clinical conditions of the patients according to the medical assessment scales, forcing them to frequently undergo clinical tests at the hospital. To respond to this demand, we propose the use of a bilateral master/slave haptic system that could allow the clinician, who interacts with the master, to assess remotely and in real time the clinical conditions of the patient that uses the home rehabilitation device as the slave. In this paper, we describe a proof of concept to highlight the main issues of such an application, limited to one degree of freedom, and to the measure of the stiffness and range of motion of the hand.

Usability and reliability of a remotely administered adult autism assessment, the autism diagnostic observation schedule (ADOS) module 4.

INTRODUCTION: The Autism Diagnostic Observation Schedule (ADOS) Module 4 is an autism assessment designed for verbally fluent adolescents and adults. Because of a shortage of available clinical expertise, it can be difficult for adults to receive a proper autism spectrum disorder (ASD) diagnostic assessment. A potential option to address this shortage is remote assessment. The objective of this study was to examine the feasibility, usability, and reliability of administering the ADOS Module 4 remotely using the Versatile and Integrated System for Telerehabilitation (VISYTER). MATERIALS AND METHODS: VISYTER consists of computer stations at the client site and clinician site for video communication and a Web portal for managing and coordinating the assessment process. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote ADOS and a face-to-face ADOS were administered. After completing the remote ADOS, participants completed a satisfaction survey. RESULTS: Participant satisfaction with the remote ADOS delivery system was high. The kappa value was greater than 0.61 on 21 of 31 ADOS items. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely (interclass coefficient=0.92). Non-agreement may have been due to outside factors or practice effect despite a washout period. CONCLUSIONS: The results of this study demonstrate that an autism assessment designed to be delivered face to face can be administered remotely using an integrated Web-based system with high levels of usability and reliability.