School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Bruyère Research Institute, Ottawa, ON, Canada.
JMIR Form Res. 2024 Sep 2;8:e47246. doi: 10.2196/47246.
There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance.
This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually.
The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures.
In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method.
Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/40446.
目前，对于经历持续性脑震荡后身体症状的患者，无论是现场评估还是远程评估，都几乎没有可用的指导，也没有统一的评估工具包。由于缺乏专家共识和指导，选择最合适的现场和远程身体评估方法具有挑战性。
本研究使用专家共识流程，确定目前用于评估 5 个受脑震荡影响的身体领域的临床措施（神经检查、颈椎、前庭、眼动或用力），并确定虚拟应用已识别措施的可行性。
采用德尔菲法。在第一轮中，经验丰富的临床医生接受了关于在脑震荡评估中使用措施的调查。在第二轮中，临床医生审查了第一轮中通过至少 15%（58 名中的 9 名）参与者审查的所有措施的心理测量特性的信息。在第二轮中，专家根据他们的临床经验和记录的心理测量特性，对措施进行了从最相关到最不相关的排序。然后，由 4 名专家临床医生组成的工作组确定最后一组措施远程管理的可行性。
共有 59 名临床医生完成了第一轮调查，列出了他们用于评估受脑震荡影响的身体领域的所有措施。确定了 146 种不同措施的频数计数。此外，33 名临床医生完成了第二轮调查，并对第一轮保留的符合 15%截止标准的 22 项措施进行了排序。排名第一的措施是协调、运动范围、前庭眼动筛查和平稳追踪。工作组成员认为这些措施可以远程管理；但是，建议对远程管理进行修改，例如调整测量方法。
临床医生将协调评估（指鼻试验和快速交替运动试验）、颈椎活动范围、前庭眼动筛查和平稳追踪等作为各自领域最相关的措施。根据专家意见，这些临床措施被认为在远程环境下进行脑震荡体格检查是可行的，需要进行修改；但是，心理测量特性尚未得到探讨。
