Investigation of the validity and reliability of tele-assessment of upper extremity functions in individuals with stroke

Abstract

Objective: This study aimed to investigate the validity and reliability of assessment tools used to evaluate upper extremity function in individuals with stroke using a tele-assessment approach. Methods: Twenty-four individuals with stroke (mean age: 61.13 +/- 12.56 years), aged 18-75 years and classified as Brunnstrom stage >= 3 for upper extremity and hand function, were included. Upper extremity function was assessed using the Motor Activity Log-28 (MAL-28), Duru & ouml;z Hand Index (DHI), ABILHAND-Stroke Hand Function Questionnaire (ASQ), Nine-Hole Peg Test (NHPT), and Fugl-Meyer Upper Extremity Motor Assessment (FM-UE) using face-to-face and tele-assessment. Tele-assessment sessions were video-recorded and re-evaluated by the same physiotherapist after 3 weeks. Results: The NHPT completion times for the non-affected hand were significantly longer during tele-assessment than during the face-to-face assessment (p < 0.001). Agreement among face-to-face assessment, tele-assessment, and repeated tele-assessment was good for DHI dressing, NHPT non-affected hand, and FM-UE coordination and speed subscales (intra-class correlation coefficient (ICC) = 0.80-0.90), while all other measures showed excellent agreement (ICC > 0.90). Intra-rater reliability between tele-assessment and repeated tele-assessment was good for the FM-UE coordination and speed subscales (ICC = 0.834) and excellent for all remaining measures. The affected side (right/left) did not significantly influence tele-assessment outcomes (p > 0.05). Conclusion: The MAL-28, DHI, ASQ, NHPT, and FM-UE can be administered reliably via tele-assessment to evaluate upper extremity function in individuals with stroke. Tele-assessment represents a valid and reliable alternative for functional evaluations that can be conducted verbally and do not require physical guidance, particularly for individuals with limited access to healthcare services.