Valutazione della funzione motoria da remoto nella persona con disordine neurologico: una revisione sistematica.

Scritto da

Andrea Baroni

in

Valutazione della funzione motoria da remoto nella persona con disordine neurologico: una revisione sistematica.

Remote assessment of motor performance in neurological disorders: a systematic review.

Autori

Baroni Andrea (Ferrara University, Ferrara, Italy)

Carpineto Andrea (Ferrara University, Ferrara, Italy)

Fregna Giulia (Ferrara University, Ferrara, Italy)

Antonioni Annibale (Ferrara University, Ferrara, Italy)

Peracchiotti Gabriele (Ferrara University, Ferrara, Italy)

Flacco Maria Elena (Ferrara University, Ferrara, Italy)

Straudi Sofia (Ferrara University, Ferrara, Italy)

Introduction

Interest in telerehabilitation has continuously grown in recent years due to the possibility of increasing patients’ accessibility to rehabilitation services and continuity of care1. Clinical evaluation of motor performance represents a crucial point of the rehabilitative process, allowing the identification of patient needs and the planning of personalized treatment2. Several methods have been studied to remotely investigate motor performance of people with neurological disorders using wearable devices and sensors, making the assessment expensive and dependent on the clinician to provide the necessary device. For these reasons, with this systematic review, we aim to synthesize the evidence about the available assessment tools for the evaluation of motor performance that can be administered remotely. Furthermore, we aim to collect data about the reliability, validity, feasibility, and acceptability of their use in the clinical setting.

Methods

This systematic review was conducted following the updated version of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines3. The study was registered in the “International Prospective Register of Systematic Reviews” (PROSPERO, CRD42024549094). The search was carried out in MEDLINE (via PubMed), EMBASE, CINAHL, and ScienceDirect. We included all observational and interventional studies that assess motor performance remotely in adults (18 years or older) with neurological disorders, including, but not limited to stroke, multiple sclerosis (MS), Parkinson’s disease (PD), acquired brain injury (ABI), and spinal cord injury (SCI). The assessment had to be conducted by a clinician on real patients via video recording or video conferencing (synchronous or asynchronous). The primary outcome had to be the reliability of the remote assessment tool compared to a reference standard of any kind performed through a validated measure or carried out in person. Secondary outcomes could be the validity, feasibility, and acceptability of the motor assessment tools performed remotely.

Results

Database searching identified 2541 records. After removing duplicates, 2390 were screened for title and abstract, and 2069 were excluded. Among the 321 remaining papers, 296 didn’t meet the inclusion criteria and were excluded from the collection. We included 25 papers in our systematic review. Of the included studies, 11 evaluated people with PD and 9 people with stroke; the remaining 5 remotely evaluated mixed neurological populations, including MS and SCI. Looking at PD, 6 studies used the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS); upper and lower limb function was evaluated in 3 and 2 studies respectively, and gait and balance were evaluated in 5 studies. Looking at studies on people with stroke, upper and lower extremity function were evaluated in 5 and 4 studies respectively. Balance was evaluated in 4 studies, walking function in 2. The remaining 5 studies evaluated different aspects of motor performance. All studies on people with PD showed high levels of reliability and validity, representing a feasible resource for PD remote evaluation. Studies on people with stroke suggest good applicability of remote assessment, although data on upper limb function have shown poor reliability. The high heterogeneity of the remaining studies didn’t allow us to draw general conclusions on the other populations.

Discussion and Conclusion

Remote assessment represents a valuable option for the evaluation of rehabilitative needs and the definition of achievable rehabilitative goals. People with PD and people with stroke seem to be those who could benefit from remote evaluation of motor performance without using wearable devices and sensors, showing levels of reliability and validity comparable to in-person assessment. The acceptability and safety of remote assessment represent an added value to improve accessibility to care of people with neurological disorders. A comprehensive analysis of the results and the evaluation of the quality of the studies might confirm our preliminary results.

REFERENCES

  1. Brennan DM, Tindall L, Theodoros D, et al. A blueprint for telerehabilitation guidelines–October 2010. Telemed J E Health. 2011;17(8):662-665. doi:10.1089/tmj.2011.0036
  2. O’Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review. Digit Health. 2023;9:20552076231183233. Published 2023 Jun 22. doi:10.1177/20552076231183233
  3. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Published 2021 Mar 29. doi:10.1136/bmj.n71

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