Equivalence of In-person and Telehealth Administration of the Physical and Neurological Examination of Subtle Signs Timed Motor Subscale in Youth Recovered from Concussion and Healthy Controls

ABSTRACT

Background and/or Objectives: The Physical and Neurological Examination of Subtle Signs (PANESS) shows promise as a tool for detecting subtle motor dysfunction after concussion. Our objective was to examine the equivalence of in-person and telehealth administration of the Timed Motor portion of the PANESS in youth recovered from concussion and healthy controls. Design(s) Data was collected as part of a longitudinal cohort-controlled observational study. Setting(s) Clinical research lab and via telehealth. Participant(s) 14 youth (Mean age =14.3, SD=2.41;71.4% female) participating in the last visit of a study examining neural recovery following concussion (7 participants clinically recovered from concussion [Mean years since injury= 1.38, SD= 0.24] and 7 neverconcussed controls). Intervention(s) Not applicable. Main Outcome Measure(s) The PANESS is a brief exam designed to evaluate subtle signs of neuromotor dysfunction in children. The Timed Motor portion requires the participant to complete rapid sequential movements and accounts for speed as well as presence of motor overflow and dysrhythmia scores range from 0-64, higher scores reflect worse performance. In this study, PANESS Timed Motor scores were obtained first via in-person administration and then, within 1 week (Median=0 days), via telehealth administration. Prior research shows high test-retest reliability for in-person administration. Result(s) Paired-sample t-test showed no significant difference between scores obtained in-person (M=15.14 SD= 1.775) and via Zoom (M=15.36;SD=1.848), t (13)= -0.145 p= 0.887. Conclusion(s) The PANESS was developed for inperson administration. During the COVID-19 pandemic, many measures were adapted for telehealth without data suggesting equivalence across administration contexts. Use of telehealth measures has the potential to reduce participant burden and improve access to clinical care. Here, we provide preliminary evidence to suggest equivalence of the PANESS Timed Motor scores obtained in-person and via telehealth in select youth. Future work should explore the psychometric properties of measures adapted for telehealth administration and the emerging utility of the PANESS related to concussion.