Application of Commonly Used Physical Tests in Patients with Concussion to Patients with Various Types and Severities of Acquired Brain Injury: a Method Comparison Study (Preprint)

BACKGROUND People who sustain a concussion and live in remote areas can experience challenges to accessing specialized assessments. In these cases, virtual approaches to assessment are of value. There is limited information on important psychometric properties of physical assessment measures used to evaluate people post-concussion virtually. OBJECTIVE The objectives of this method-comparison study were to determine i) inter/intra-rater reliability of a battery of concussion physical tests administered virtually in people with brain injury and ii) sensitivity and specificity of the virtual battery when compared to the in-person assessment. METHODS Sixty people living with acquired brain injuries attended an in-person and virtual assessment, at the Ottawa Hospital Rehabilitation Centre. The order of the assessments, in-person and virtual, was randomized. The following physical measures were administered in person and virtually: finger-to-nose test, Vestibular/Ocular Motor Screening (VOMS), static balance testing (double leg, single leg, tandem), saccades, cervical spine range of motion, and evaluation of effort. The virtual assessment was recorded and a second clinician viewed and independently documented findings from the recordings twice at one-month intervals. RESULTS The sensitivity metrics ranged from moderate (60%) to excellent (100%) for saccades and cervical spine lateral flexion measures, respectively. Specificity ranged from 75% to 100% for left single leg stance eyes closed and left finger-to-nose testing, respectively. The inter-rater reliability ranged from poor for cervical spine extension (Cohen’s Kappa = 0.20) to excellent for VOMS change in symptoms (Cohen’s Kappa = 0.93). The intra-rater reliability ranged from poor for cervical spine extension (Cohen’s Kappa = 0.31) to excellent for the finger-to-nose testing on the right (Cohen’s Kappa = 0.90). CONCLUSIONS This study provides information on the psychometric properties associated with virtual administration of concussion measures. The VOMS change in symptoms measure appears to have most promising properties when administered virtually. Caution should be maintained when administering certain concussion measures virtually. INTERNATIONAL REGISTERED REPORT RR2-10.2196/57663

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