Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist

Abstract

Objective To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. Design Systematic review. Subjects Individuals with neurological conditions. Intervention Not applicable. Main measures The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. Results From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as “sufficient” in a study with appropriate methodological quality (“very good” or “adequate”). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. Conclusion The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. Registration number CRD42021257662.

Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation

“…The authors of a 2022 review discussed the paucity of information on remote examination in neurologic populations and recommended future studies consider both the clinical utility and psychometrics of developing tools29 We conducted a pilot evaluation of the validity of a modified version of the UEFMA. Despite the time recommended for examiner training,45 the tUEFMA is a cost-effective tool that does not require advanced technology, or additional software/hardware beyond that needed for a telerehabilitation encounter 32,45.…”

“…While 8 tools were recommended, none targeted arm function post-stroke. Importantly, no tool reviewed was found to have published data on relevant psychometric properties and clinical utility 29…”

“…All aspects of the episode of care should be available remotely to fully realize the benefits of telerehabilitation. Brito and colleagues 29 reviewed measurement tools used in the telerehabilitation of individuals with neurologic conditions, including 20 tools for stroke. While 8 tools were recommended, none targeted arm function post-stroke.…”

“…Importantly, no tool reviewed was found to have published data on relevant psychometric properties and clinical utility. 29 In this preliminary validity study, we targeted the examination of upper extremity impairment in those with moderate to severe stroke. The Upper Extremity Subscale of the Fugl-Meyer Assessment (UEFMA) [30][31][32] is an outcome measure widely used in a face-to-face format in clinical and research settings to evaluate the presence and severity of arm impairment and motor recovery post-stroke.…”