Telerehabilitation for people with physical disabilities and movement impairment: development and evaluation of an online toolkit for practitioners and patients.

PURPOSE: Telerehabilitation has increasingly been used since the COVID-19 pandemic but with limited guidance available on undertaking physical assessments using remote methods. We aimed to provide such guidance by developing a Telerehab Toolkit, an online information and training resource for practitioners, patients, and carers on telerehabilitation for people with physical disabilities and movement impairment. MATERIALS AND METHODS: Development and evaluation of the toolkit were informed by the Knowledge to Action framework and took place iteratively in two phases-knowledge creation and action. Information was collated from various sources including literature review, online survey, service evaluation, and focus group discussions. The toolkit has been evaluated using think-aloud interviews, e-mail and social media feedback from users, and analytics data on user engagement with the website. RESULTS: The Telerehab Toolkit focuses on remote physical assessments, and contains information on technology, digital skills, remote assessment tools, information governance, and safety for telerehabilitation. Resources include top tips from practitioners and patients, how-to guides, checklists, videos, and links to evidence. CONCLUSIONS: The Telerehab Toolkit has been well-received by practitioners, healthcare students, patients, and carers, is being disseminated widely, and is freely available (www.plymouth.ac.uk/research/telerehab). IMPLICATIONS FOR REHABILITATIONTelerehabilitation has been increasingly used since the COVID-19 pandemic, but with limited guidance and training for practitioners on undertaking safe and effective remote physical assessments.The Telerehab Toolkit has been developed iteratively using the Knowledge to Action framework; it is a free online resource for practitioners and patients with specific guidance on telerehabilitation for physical disabilities and movement impairment.It is anticipated that the resource will help to improve the knowledge, skills, and confidence of the current and future rehabilitation workforce.

Theoretical and practical assessments over SSH

During the COVID-19 pandemic, universities worldwide were forced to close, causing a shift from presential to remote classes. This situation motivated teachers to find suitable tools to evaluate students remotely, fairly, and accurately. However, currently available systems are either survey or exercise evaluation based, not suitable for competency-based assessments. Faced with this context and limitations of available evaluation systems, we developed TestsOverSSH, a system to devise, deliver, and automatically correct assessments performed in a Command Line Interface (CLI) environment. Unique assessments are generated per student when they access the proposed system via Secure SHell (SSH). TestsOverSSH is composed of shell scripts that orchestrate a series of tools and services that come pre-installed in Linux distributions. It can be used to construct multiple-choice or direct answer questions while also requiring students to perform tasks in the environment per se, namely computer programming or CLI manipulation-related assignments. We present examples of the question types in this system, explaining question formats and operating guidelines. Since the assessments are directly performed in the system, logs and command history can be easily retrieved while keeping information within student devices uncollected. We performed evaluations using this system in a real context and obtained student feedback through a custom survey and the System Usability Scale (SUS). Survey results and SUS score suggest that TestsOverSSH is an intuitive evaluation tool, with eased access and usage, making it applicable for e-learning. © The Author(s). 2023.

Strategies, recommendations, and validation of remote executive function tasks for use with young children

Research and development on remote assessments and services have been slowly progressing over the past decade in the areas of telehealth, telemedicine, and psychological e-Visits. However, much less research has focused on understanding whether neuropsychological and educational assessments can be converted for remote use with young children. In the present study, we tested the feasibility of administering a remote battery of executive function (EF) tasks to preschool students. These tasks were converted from widely used EF assessments and were administered to children in their homes remotely via Zoom Video Communications web conferencing services. Based on our experiences in the field, we described the task conversion process;highlighted the unique challenges and solutions to obtaining accurate and reliable data remotely;and presented psychometric findings from a preliminary study of 97 preschool students (Mage = 53.2 months;53% Female;55% Black, 33.7% White, 7.9% biracial, 2.2% "other," 1.1% Asian/Pacific Islander;7.2% Latine). Results revealed that the remotely assessed Day and/or Night Stroop task, Dimensional Card Change Sort (DCCS) task, Revised Head-Toes-Knees-Shoulders (HTKS-R) task, and Digit Span Forward task demonstrated strong evidence of normality, were highly reliable, and were related to children's academic achievement. Further, associations between our remote EF measures and standardized tests of academic achievement were stronger for math than for reading achievement. Overall, this study represents a first step towards developing a protocol for task conversion and remote administration of EF measures with young children.

All eyes on me: Remote online assessments for health professional programs during a pandemic.

Background: Due to the unprecedented COVID-19 pandemic, learning institutions were faced with many challenges while transitioning their in-person courses to an online format for teaching, learning, and testing. One of these challenges included the continuation of assessments in a safe but secure manner. Discussion: Professional health programs may need to implement new policies to ensure a fair, safe testing process that maintains exam integrity during remote assessments. We concluded that transitioning to remote assessments for health professional schools posed many challenges. Further studies may elaborate the effectiveness and limitations of the various approaches used for remote assessments by professional health programs during the pandemic.

Public attitudes to the use of remote data collection in clinical research.

BACKGROUND/AIMS: Coronavirus Disease 2019 (COVID-19) has presented an unprecedented challenge for delivering clinical research. The use of technology-assisted data collection for clinical research is desirable for many practitioners, but the acceptability of use in the general population has not been assessed. The aim of the study was to assess attitudes towards using technology-assisted remote methods in the delivery of clinical research in the UK and to understand the barriers to taking part in research with respect to both remote assessments and traditional research methods across different age ranges. METHODS: The study was conducted as an online anonymous survey with a 4-part questionnaire, between August 2020 and December 2020. Participants living in the UK aged 18 years and above were eligible to take part. RESULTS: A total 351 completed the survey and are included in the data analysis. In all age groups, participants identified that use of online assignments, video calls and telephone calls would make them more likely to take part in clinical research. Overall, the largest barrier to taking part in research was time commitments and timing of the appointment. COVID-19 has had a small, positive influence on the confidence of using technology in the general population. CONCLUSIONS: The study found that there is a large interest in taking part in research using online, telephone and video call appointments, which could facilitate research delivery in light of ongoing COVID-19-related restrictions and also improve the accessibility and inclusivity of research.

The Impact of Clinical Setting on Evaluating Patients Using the PROMIS-29 Baseline Measures in the COVID Era: A Retrospective Multicenter Quantitative Analysis.

BACKGROUND: Multidimensional patient-reported outcomes are a critical part of assessing patients to better understand their well-being during treatment. The PROMIS-29 assessment tool is utilized as a component of assessing multidimensional pain scales. It includes patient-reported measures of pain, mood, sleep, social participation, and function. Currently, there are no data on whether a patient's immediate environment (remote versus in person) influences the reported patient outcomes measurement of a multidimensional tool represented as PROMIS-29 data. METHODS: Retrospective analysis of prospectively collected data was performed. Subjects were identified and consecutively enrolled upon entry into a chronic pain or spine center in the United States. The PROMIS-29 v2.1 was recorded. Statistical differences were assessed among age groups and across the seven domains of the assessment. RESULTS: A total of 25,187 distinct patients were enrolled in the study from August 2018 to December 2020 with a presenting baseline measurement of PROMIS-29. The PROMIS-29 v2.1 was evaluated across the seven domains, and subgroup age analysis was performed for patients completing surveys in the clinical setting (non-remote group) and those completing the survey in the remote setting (remote group) during entry into spine and pain practices across the United States. For mental health scores, those less than 40 years of age and those over 80 years of age showed significant differences in ratings of anxiety and depression in the remote versus non-remote setting. Regarding physical health scores, those aged 60-79 showed a significant difference in the remote versus non-remote ratings for pain interference (p = 0.005; 63.9 vs. 64.4), physical function (p = 0.000; 36.4 vs. 35.7), and fatigue (p = 0.020; 57.2 vs. 57.7), while subjects over 80 years of age showed a statistical difference between the remote versus non-remote setting only in rating physical function (p = 0.025; 33.0 vs. 34). Notably, the rating of sleep disturbance in the remote versus non-remote setting was the only significant variable in the 40-59 age category (p = 0.000; 60.0 vs. 59.1). Those less than 40 years of age also reported a significant difference in the remote versus non-remote setting when rating sleep disturbance (p = 0.000; 60.5 vs. 58.9). With regard to social function, only those older than 80 years showed a significant difference in rating of ability in the remote compared to the non-remote setting (p = 0.031; 39.6 vs. 40.7). CONCLUSIONS: This data set is the first published data describing the influence of environment (remote versus in person) on PROMIS-29 outcome measurements in the chronic pain population.

Using Digital Tools to Advance Alzheimer's Drug Trials During a Pandemic: The EU/US CTAD Task Force.

The 2020 COVID-19 pandemic has disrupted Alzheimer's disease (AD) clinical studies worldwide. Digital technologies may help minimize disruptions by enabling remote assessment of subtle cognitive and functional changes over the course of the disease. The EU/US Clinical Trials in Alzheimer's Disease (CTAD) Task Force met virtually in November 2020 to explore the opportunities and challenges associated with the use of digital technologies in AD clinical research. While recognizing the potential of digital tools to accelerate clinical trials, improve the engagement of diverse populations, capture clinically meaningful data, and lower costs, questions remain regarding the stability, validity, generalizability, and reproducibility of digital data. Substantial concerns also exist regarding regulatory acceptance and privacy. Nonetheless, the Task Force supported further exploration of digital technologies through collaboration and data sharing, noting the need for standardization of digital readouts. They also concluded that while it may be premature to employ remote assessments for trials of novel experimental medications, remote studies of non-invasive, multi-domain approaches may be feasible at this time.

Considerations for assessing physical function and physical activity in clinical trials during the COVID-19 pandemic.

The coronavirus disease-2019 (COVID-19) pandemic has changed the conduct of clinical trials. For studies with physical function and physical activity outcomes that require in-person participation, thoughtful approaches in transitioning to the remote research environment are critical. Here, we share our experiences in transitioning from in-person to remote assessments of physical function and activity during the pandemic and highlight key considerations for success. Details on the development of the remote assessment protocol, integration of a two-way video platform, and implementation of remote assessments are addressed. In particular, procedural challenges and considerations in transitioning and conducting remote assessments will be discussed in terms of efforts to maintain participant safety, maximize study efficiency, and sustain trial integrity. Plans for triangulation and analysis are also discussed. Although the role of telehealth platforms and research activities in remote settings are still growing, our experiences suggest that adopting remote assessment strategies are useful and convenient in assessing study outcomes during, and possibly even beyond, the current pandemic. Trial register and number: ClinicalTrials.gov [NCT03728257].