Neuropsychological Test Administration by Videoconference: A Systematic Review and Meta-Analysis
The purpose of the current systematic review and meta-analysis was to assess the effect of videoconference administration on adult neurocognitive tests. We investigated whether the scores acquired during a videoconference administration were different from those acquired during on-site administration. Relevant counterbalanced crossover studies were identified according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twelve studies met criteria for analysis. Included samples consisted of healthy adults as well as those with psychiatric or neurocognitive disorders, with mean ages ranging from 34 to 88 years. Heterogenous data precluded the interpretation of a summary effect for videoconference administration. Studies including particpants with a mean age of 65–75, as well as studies that utilized a high speed network connection, indicated consistent performance across videoconference and on-site conditions, however studies with older participants and slower connections were more variable. Subgroup analyses indicated that videoconference scores for untimed tasks and those allowing for repetition fell 1/10th of a standard deviation below on-site scores. Test specific analyses indicated that verbally-mediated tasks including digit span, verbal fluency, and list learning were not affected by videoconference administration. Scores for the Boston Naming Test fell 1/10th of a standard deviation below on-site scores. Heterogenous data precluded meaningful interpretation of tasks with a motor component. The administration of verbally-mediated tasks by qualified professionals using existing norms was supported, and the use of visually-dependent tasks may also be considered. Variability in previous studies indicates a need for further investigation of motor-dependent tasks. We recommend the development of clinical best practices for conducting neuropsychological assessments via videoconference, and advocate for reimbursement structures that allow consumers to benefit from the increased access, convenience, and cost-savings that remote assessment provides.
KeywordsTeleneuropsychology Telepsychology Telehealth Telemedicine Mhealth Assessment
This research was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness, Research, and Treatment and the Mid-Atlantic Mental Illness Research, Education, and Clinical Center (VISN 6 MIRECC) of the Department of Veterans Affairs Office of Mental Health Services. Special thanks to Larry A. Tupler for his support of this and other related teleneuropsychology investigations within the VISN 6 MIRECC.
- Acierno, R., Gros, D. F., Ruggiero, K. J., Hernandez-Tejada, B. M. A., Knapp, R. G., Lejuez, C. W., et al. (2016). Behavioral activation and therapeutic exposure for posttraumatic stress disorder: a noninferiority trial of treatment delivered in person versus home-based telehealth. Depression and Anxiety. doi: 10.1002/da.22476.
- Ball, C. J., Scott, N., McLaren, P. M., & Watson, J. P. (1993). Preliminary evaluation of a low-cost videoconferencing (LCVC) system for remote cognitive testing of adult psychiatric patients. British Journal of Clinical Psychology, 32(3), 303–307. doi: 10.1111/j.2044-8260.1993.tb01060.x.CrossRefPubMedGoogle Scholar
- Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2015). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health. doi: 10.1089/tmj.2015.0206.
- Beglinger, L. J., Gaydos, B., Tangphao-Daniels, O., Duff, K., Kareken, D. A., Crawford, J., et al. (2005). Practice effects and the use of alternate forms in serial neuropsychological testing. Archives of Clinical Neuropsychology, 20(4), 517–529. doi: 10.1016/j.acn.2004.12.003.CrossRefPubMedGoogle Scholar
- Cheung, M. W.-L., & Vijayakumar, R. (2016). A guide to conducting a meta-analysis. Neuropsychology Review, 1–8. doi: 10.1007/s11065-016-9319-z.
- Ciemins, E., Halloway, B., Coon, P. J., McClosky-Armstrong, T., & Min, S. (2009). Telemedicine and the Mini-mental state Examination: Assessment from a distance. Telemedicine and e-Health. doi: 10.1089/tmj.2008.0144.
- Cohen, J. (1988). Statistical power analysis for the behavioral Sciences. Hillsdale: L. Erlbaum Associates.Google Scholar
- Cullum, C., Hynan, L., Grosch, M., Parikh, M., & Weiner, M. (2014). Teleneuropsychology: evidence for video teleconference-based neuropsychological assessment. Journal of the International Neuropsychological Society, 20(10), 1028–1033. doi: 10.1017/S1355617714000873.CrossRefPubMedCentralGoogle Scholar
- DeYoung, N., Belkonen, S., Luci, K., Slater, M., Quigley, T., & Shenal, B. (2015). The reliability and accuracy of administering the Montreal cognitive assessment over telehealth. Presented at the 43rd annual meeting of the International neuropsychological Society, Denver, CO.Google Scholar
- Ding, H., Hu, G. L., Zheng, X. Y., Chen, Q., Threapleton, D. E., & Zhou, Z. H. (2015). The method quality of cross-over studies involved in Cochrane systematic reviews. PloS One, 10(4). doi: 10.1371/journal.pone.0120519.
- Duff, K. (2012). Evidence-based indicators of neuropsychological change in the individual patient: relevant concepts and methods. Archives of Clinical Neuropsychology, 27(3), 248–261. doi: 10.1093/arclin/acr120.
- Fordyce, M. A., Chen, F. M., Doescher, M. P., & Hart, L. G. (2007). 2005 physician supply and distribution in rural areas of the United States. Final report, 116. http://depts.washington.edu/uwrhrc/uploads/RHRC%20FR116%20Fordyce.pdf. Accessed 20 July 2016.
- Fortney, J. C., Pyne, J. M., Turner, E. E., Farris, K. M., Normoyle, T. M., Avery, M. D., et al. (2015). Telepsychiatry integration of mental health services into rural primary care settings. International Review of Psychiatry, 27(6), 525–539. doi: 10.3109/09540261.2015.1085838.CrossRefPubMedGoogle Scholar
- Galusha-Glasscock, J. M., Horton, D. K., Weiner, M. F., & Cullum, C. M. (2015). Video teleconference administration of the Repeatable Battery for the assessment of neuropsychological status. Archives of Clinical Neuropsychology. doi: 10.1093/arclin/acv058.
- Harrell, K. M., Wilkins, S. S., Connor, M. K., & Chodosh, J. (2014). Telemedicine and the evaluation of cognitive impairment: the additive value of neuropsychological assessment. Journal of the American Medical Directors Association, 15(8), 600–606. doi: 10.1016/j.jamda.2014.04.015.CrossRefPubMedGoogle Scholar
- Higgins, J. P., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions. http://handbook.cochrane.org/front_page.htm. Accessed 8 Apr 2016.
- Hilty, D. M., Nesbitt, T. S., Kuenneth, C. A., Cruz, G. M., & Hales, R. E. (2007). Rural versus suburban primary care needs, utilization, and satisfaction with telepsychiatric consultation. The Journal of Rural Health, 23(2), 163–165. doi: 10.1111/j.1748-0361.2007.00084.x.CrossRefPubMedGoogle Scholar
- Jacobsen, S. E., Sprenger, T., Andersson, S., & Krogstad, J.-M. (2003). Neuropsychological assessment and telemedicine: a preliminary study examining the reliability of neuropsychology services performed via telecommunication. Journal of the International Neuropsychological Society, 9(3), 472–478. doi: 10.1017/S1355617703930128.CrossRefPubMedGoogle Scholar
- McEachern, W., Kirk, A., Morgan, D. G., Crossley, M., & Henry, C. (2008). Reliability of the MMSE administered in-person and by telehealth. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 35(5), 643–646. doi: 10.1017/S0317167100009458.CrossRefPubMedGoogle Scholar
- Menon, A. S., Kondapavalru, P., Krishna, P., Chrismer, J. B., Raskin, A., Hebel, J. R., & Ruskin, P. E. (2001). Evaluation of a portable low cost videophone system in the assessment of depressive symptoms and cognitive function in elderly medically ill veterans. The Journal of Nervous and Mental Disease, 189(6), 399–401.CrossRefPubMedGoogle Scholar
- Montani, C., Billaud, N., Tyrrell, J., Fluchaire, I., Malterre, C., Lauvernay, N., et al. (1997). Psychological impact of a remote psychometric consultation with hospitalized elderly people. Journal of Telemedicine and Telecare, 3(3), 140–145. doi: 10.1258/1357633971931048.
- Parikh, M., Grosch, M. C., Graham, L. L., Hynan, L. S., Weiner, M., Shore, J. H., & Cullum, C. M. (2013). Consumer acceptability of brief videoconference-based neuropsychological assessment in older individuals with and without cognitive impairment. The Clinical Neuropsychologist, 27(5), 808–817. doi: 10.1080/13854046.2013.791723.CrossRefPubMedPubMedCentralGoogle Scholar
- Shores, M. M., Ryan-Dykes, P., Williams, R. M., Mamerto, B., Sadak, T., Pascualy, M., et al. (2004). Identifying undiagnosed dementia in residential care veterans: comparing telemedicine to in-person clinical examination. International Journal of Geriatric Psychiatry, 19(2), 101–108. doi: 10.1002/gps.1029.CrossRefPubMedGoogle Scholar
- Temple, V., Drummond, C., Valiquette, S., & Jozsvai, E. (2010). A comparison of intellectual assessments over video conferencing and in-person for individuals with ID: preliminary data. Journal of Intellectual Disability Research, 54(6), 573–577. doi: 10.1111/j.1365-2788.2010.01282.x.CrossRefPubMedGoogle Scholar
- Turkstra, L. S., Quinn-Padron, M., Johnson, J. E., Workinger, M. S., & Antoniotti, N. (2012). In-person versus telehealth assessment of discourse ability in adults with traumatic brain injury. The Journal of Head Trauma Rehabilitation, 27(6), 424–432. doi: 10.1097/HTR.0b013e31823346fc.CrossRefPubMedPubMedCentralGoogle Scholar
- Turner, T. H., Horner, M. D., Vankirk, K. K., Myrick, H., & Tuerk, P. W. (2012). A pilot trial of neuropsychological evaluations conducted via telemedicine in the veterans health administration. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 18(9), 662–667. doi: 10.1089/tmj.2011.0272.CrossRefGoogle Scholar
- Wadsworth, H. E., Galusha-Glasscock, J. M., Womack, K. B., Quiceno, M., Weiner, M. F., Hynan, L. S., et al. (2016). Remote neuropsychological assessment in rural American Indians with and without cognitive impairment. Archives of Clinical Neuropsychology, acw030. doi: 10.1093/arclin/acw030.
- Wennergren, J., Munshi, I., Fajardo, A. D., & George, V. V. (2014). Implementation of clinical video telemedicine (CVT) within a VA medical center is cost effective and well received by veterans. International Journal of Clinical Medicine, 5(12), 711–716. doi: 10.4236/ijcm.2014.512097.CrossRefGoogle Scholar