Accuracy and Reliability of Remote Categorization of Upper Limb Outcome After Stroke.
Harry T Jordan, Cathy M Stinear
PMID 38357877WHAT IT FOUND
Remote video assessment matched in-person upper limb outcome for 88% at 3 months and 96% at 6 months.
It was less accurate at the chronic stage, 75% and 79%, and for the Good and Limited categories.
Key findings
01The remote FOCUS-4 assessment put participants in the same upper limb outcome category as the in-person ARAT for 88% at 3 months and 96% at 6 months.
02At the chronic stage, the first and second remote FOCUS-4 assessments matched the ARAT for 75% and 79% of participants.
03Two remote FOCUS-4 assessments placed 82% of chronic participants in the same category, and 9 of the 10 people classified differently were placed in a better category on the second assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Small samples were used at 3 months and 6 months, with 26 and 27 participants, and there was no planned sample size for the remote assessments. The distribution was skewed toward the outer categories, so there were few people in the Good or Limited categories; only 1 participant was in the Limited category at 3 months. The remote FOCUS-4 tasks were not performed in the intended decision-tree order, so the effect of task order is unknown. One assessor performed almost all assessments, which reduces assessor differences but may introduce bias. The analyses were exploratory and had no pre-specified thresholds for deciding whether accuracy was acceptable. The 3-month and 6-month samples overlapped with the chronic sample, so the results are not independent across timepoints. Some planned gaps between assessments were not feasible, and the randomized order was not always followed.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not conclude that remote video categorization is ready for routine clinical decisions for every person after stroke. It was less accurate at the chronic stage and for the Good and Limited categories, and the study was exploratory with small samples.