使用注意力缺陷/多动障碍评定量表-IV 对神经发育障碍儿童及其照顾者进行远程精神病学评估的可靠性：随机可行性研究。
Reliability of Telepsychiatry Assessments Using the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study.
机构信息
Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan.
出版信息
J Med Internet Res. 2024 Feb 19;26:e51749. doi: 10.2196/51749.
BACKGROUND
Given the global shortage of child psychiatrists and barriers to specialized care, remote assessment is a promising alternative for diagnosing and managing attention-deficit/hyperactivity disorder (ADHD). However, only a few studies have validated the accuracy and acceptability of these remote methods.
OBJECTIVE
This study aimed to test the agreement between remote and face-to-face assessments.
METHODS
Patients aged between 6 and 17 years with confirmed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses of ADHD or autism spectrum disorder (ASD) were recruited from multiple institutions. In a randomized order, participants underwent 2 evaluations, face-to-face and remotely, with distinct evaluators administering the ADHD Rating Scale-IV (ADHD-RS-IV). Intraclass correlation coefficient (ICC) was used to assess the reliability of face-to-face and remote assessments.
RESULTS
The participants included 74 Japanese children aged between 6 and 16 years who were primarily diagnosed with ADHD (43/74, 58%) or ASD (31/74, 42%). A total of 22 (30%) children were diagnosed with both conditions. The ADHD-RS-IV ICCs between face-to-face and remote assessments showed "substantial" agreement in the total ADHD-RS-IV score (ICC=0.769, 95% CI 0.654-0.849; P<.001) according to the Landis and Koch criteria. The ICC in patients with ADHD showed "almost perfect" agreement (ICC=0.816, 95% CI 0.683-0.897; P<.001), whereas in patients with ASD, it showed "substantial" agreement (ICC=0.674, 95% CI 0.420-0.831; P<.001), indicating the high reliability of both methods across both conditions.
CONCLUSIONS
Our study validated the feasibility and reliability of remote ADHD testing, which has potential benefits such as reduced hospital visits and time-saving effects. Our results highlight the potential of telemedicine in resource-limited areas, clinical trials, and treatment evaluations, necessitating further studies to explore its broader application.
TRIAL REGISTRATION
UMIN Clinical Trials Registry UMIN000039860; http://tinyurl.com/yp34x6kh.
背景
鉴于全球儿童精神科医生短缺以及专业护理的障碍，远程评估是诊断和管理注意力缺陷/多动障碍（ADHD）的一种有前途的替代方法。然而，只有少数研究验证了这些远程方法的准确性和可接受性。
目的
本研究旨在测试远程和面对面评估之间的一致性。
方法
从多个机构招募年龄在 6 至 17 岁之间、经确认符合《精神疾病诊断与统计手册》第五版（Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition） ADHD 或自闭症谱系障碍（autism spectrum disorder, ASD）诊断的患者。参与者以随机顺序接受 2 次评估，分别为面对面和远程评估，由不同的评估者使用 ADHD 评定量表-IV（ADHD Rating Scale-IV, ADHD-RS-IV）进行评估。采用组内相关系数（intraclass correlation coefficient, ICC）评估面对面和远程评估的可靠性。
结果
共纳入 74 名日本儿童，年龄在 6 至 16 岁之间，主要诊断为 ADHD（43/74，58%）或 ASD（31/74，42%）。共有 22 名（30%）儿童同时患有两种疾病。根据 Landis 和 Koch 标准，ADHD-RS-IV 的 ICC 显示，面对面和远程评估之间的总 ADHD-RS-IV 评分具有“中等”一致性（ICC=0.769，95%置信区间 0.654-0.849；P<.001）。在 ADHD 患者中，ICC 表现为“几乎完美”一致（ICC=0.816，95%置信区间 0.683-0.897；P<.001），而在 ASD 患者中，ICC 表现为“中等”一致（ICC=0.674，95%置信区间 0.420-0.831；P<.001），这表明两种方法在两种疾病中均具有高度可靠性。
结论
本研究验证了远程 ADHD 测试的可行性和可靠性，这种方法具有减少医院就诊次数和节省时间等潜在优势。我们的结果突显了远程医疗在资源有限地区、临床试验和治疗评估中的潜力，需要进一步研究以探索其更广泛的应用。
试验注册
UMIN 临床研究注册 UMIN000039860；http://tinyurl.com/yp34x6kh。
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