Reliability of remote gait and balance assessment of people with Parkinson's disease

ABSTRACT

Parkinson's disease is a movement disorder that increases fall risk. Clinicians administer several validated gait and balance tests for people with Parkinson's disease in person. COVID-19 has reduced healthcare access, and this has disproportionately affected older populations. We tested the reliability of remote gait and balance assessments of people with Parkinson's disease using face-to-face as the comparator. Fifteen people with Parkinson's disease (aged 57-82, 11 males) performed 14 tests of gait and balance twice (i) face-to-face, and (ii) remotely, via videoconference between 7 and 14 days after. A trained physiotherapist rated participant performance. The tests included items from the Berg Balance Scale, Functional Gait Assessment, and the Timed-Up- And-Go. These assessments have been validated face-to-face for people with Parkinson's disease. The videoconference assessment was recorded. We compared face-to-face and live videoconference performance to obtain assessment reliability. The physiotherapist rated the recording at least two weeks after the live videoconference to obtain intrarater reliability. A second rater assessed the recording, and we compared live and recorded telehealth assessments to obtain inter-rater reliability. Reliabil ity was measured using either intraclass correlation (ICC) two-way mixed with absolute agreement (continuous measures) or Fleiss multi-rater Kappa test (ordinal measures). Most tests showed moderate to very good assessment reliability between face-to-face and live telehealth (ICC=0.5-1), between face-to-face and recorded telehealth (ICC=0.5-1) and good to very good inter-rater reliability between the recorded telehealth assessments (ICC=0.63-1). Reliability appeared to be higher in tests involving quantitative, rather than qualitative, measures of performance. A ceiling effect was noted in some tests where all participants completed tests with maximum scores in both face-to-face and remote assessments. This study supports the feasibility of remote assessment in clinical practice for people with Parkinson's disease. Further research with a larger cohort and adjustment of the assessments to avoid ceiling effects is necessary.