In-person Administration Research Articles

Examining a Preclinical Alzheimer’s Cognitive Composite for Telehealth Administration, the tPACC, for Reliability between In-Person and Remote Cognitive Testing (P6-6.002)

<h3>Objective:</h3> To evaluate the concordance of tPACC scores from in-person and remote testing. <h3>Background:</h3> The clinical trial landscape in Alzheimer’s disease (AD) and related dementias is focused on targeting individuals in preclinical stages. The preclinical Alzheimer’s cognitive composite (PACC) was developed for in-person administration to capture subtle cognitive decline in amyloid positive individuals compared to amyloid negative. It is desirable to have a transportable, composite measurement sensitive to detecting cognitive changes across cognitively normal (NC) and impaired (MCI and dementia) participants. <h3>Design/Methods:</h3> We examined in-person cognitive data from 662 adults (70.2±8.1y) from the Wake Forest AD Research Center’s Clinical Core, who received clinical evaluation, cognitive testing, and adjudication. The PACC in-person only was calculated using RAVLT Delayed Recall, Digit Symbol Coding (DSC), semantic fluency, Craft Story Delayed Verbatim, and MMSE total scores using baseline NC participants as a reference. The tPACC used measurements that were available at both in-person and remote visits with modifications from the in-person PACC; Montreal Cognitive Assessment (MoCA) was used in place of MMSE, and DSC was not included. A subset analysis with PACC in-person and tPACC remote from a pilot study examined reliability between in-person and remote testing. We performed correlation analysis and generated Bland-Altman plots. <h3>Results:</h3> Of the 662 adults studied, 434 (66%) were female, 522 (79%) were White, 206 (34%) were <i>APOE</i>4 carriers, and mean education was 15.9±4.1 years. At baseline, there is a significant positive relationship between in-person tPACC and PACC (Overall group; r²=0.94, p=&lt;0.0001, n=640). Although there is a good agreement in both subgroups (Impaired: r²=0.86, p=&lt;0.0001, n=301 and NC: r²=0.90, p=&lt;0.0001, n=328), tPACC overestimates cognitive performance compared to PACC for those with lower scores. We also found good agreement between in-person PACC and remote tPACC (r²=0.83, p=&lt;0.0001, n=38). <h3>Conclusions:</h3> There is generally good agreement between tPACC and PACC for NC and impaired individuals. <b>Disclosure:</b> Miss Duran has nothing to disclose. The institution of Ms. Gaussoin has received research support from NIH. The institution of Dr. Lockhart has received research support from NIH. Dr. Rundle has nothing to disclose. The institution of Dr. Espeland has received research support from Alzheimer’s Association. The institution of Dr. Espeland has received research support from National Institutes of Health. Dr. Espeland has received personal compensation in the range of $500-$4,999 for serving as a Consultant with National Institutes of Health. Dr. Williams has nothing to disclose. Tim Hughes has nothing to disclose. Suzanne Craft has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cognito Therapeutics. Suzanne Craft has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for T3D Therapeutics. Suzanne Craft has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cyclerion Therapeutics. Suzanne Craft has received personal compensation in the range of $500-$4,999 for serving as a member, Board of Scientific Counselors with NIA. Bonnie Sachs has received research support from NIH. Bonnie Sachs has received research support from Alzheimer’s Association. The institution of Dr. Bateman has received research support from NIA.

Tele-assessment of activities and participation in chronic phase of stroke: Is use valid and viable in a developing country?

SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews. To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference. Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized. Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = -0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC2,1 = 0.66; 95%CI: 0.40-0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC2,1 = 0.55; 95%CI: 0.21-0.74) and a moderate correlation was found between the assessment methods (r = 0.43; P = 0.02). Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.

Varied performance of picture description task as a screening tool across MCI subtypes.

A picture description task is a component of Miro Health's platform for self-administration of neurobehavioral assessments. Picture description has been used as a screening tool for identification of individuals with Alzheimer's disease and mild cognitive impairment (MCI), but currently requires in-person administration and scoring by someone with access to and familiarity with a scoring rubric. The Miro Health implementation allows broader use of this assessment through self-administration and automated processing, analysis, and scoring to deliver clinically useful quantifications of the users' speech production, vocal characteristics, and language. Picture description responses were collected from 62 healthy controls (HC), and 33 participants with MCI: 18 with amnestic MCI (aMCI) and 15 with non-amnestic MCI (naMCI). Speech and language features and contrasts between pairs of features were evaluated for differences in their distributions in the participant subgroups. Picture description features were selected and combined using penalized logistic regression to form risk scores for classification of HC versus MCI as well as HC versus specific MCI subtypes. A picture-description based risk score distinguishes MCI and HC with an area under the receiver operator curve (AUROC) of 0.74. When contrasting specific subtypes of MCI and HC, the classifiers have an AUROC of 0.88 for aMCI versus HC and and AUROC of 0.61 for naMCI versus HC. Tests of association of individual features or contrasts of pairs of features with HC versus aMCI identified 20 features with p-values below 5e-3 and False Discovery Rates (FDRs) at or below 0.113, and 61 contrasts with p-values below 5e-4 and FDRs at or below 0.132. Findings suggest that performance of picture description as a screening tool for MCI detection will vary greatly by MCI subtype or by the proportion of various subtypes in an undifferentiated MCI population.

Introducing the Tele-OCS: A validated remotely administered version of The Oxford Cognitive Screen

Background Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors. Methods 40 stroke survivors (M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen’s d estimates were used to compare performance between modalities. Results We found that the proportion of OCS subtasks impaired did not differ across modalities (d = 0). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (&lt;1 point difference on average). These statistical differences did not affect impairment classifications. Conclusions The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.

Examining the Efficacy of Online Administration of a Time-Limited School Readiness Intervention in the Face of COVID-19

Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the feasibility, acceptability, and efficacy of a telemedicine delivery of the School Readiness Parenting Program (SRPP), an integrative adaptation of PCIT designed to address the behavioral and academic domains of school readiness. The present study takes the first step towards validating an online administration of the SRPP as a treatment for early childhood disruptive behavior. Data were collected for 64 children ages 2–6 years (Mage = 4.63, SD = 0.86; 78.1% Hispanic/Latinx) and their families, who received either in-person administration of time-limited PCIT (PCIT-TL; n=30) or online administration of SRPP (n=34). A series of repeated measures ANOVAS were conducted to examine within and between group effects. Results revealed that both SRPP and PCIT-TL significantly reduced inattention (d’s = −0.54 to −0.88), aggression (d’s = −0.55 to −1.06), and behavioral symptomology (d’s = −0.55 to −0.85) and produced significant gains in parental skills (d’s = −1.47 to 2.99). Notably, online SRPP demonstrated greater improvement in positive parental verbalization, whereas PCIT-TL demonstrated greater reductions in parental stress. Overall, findings support the utility of online SRPP for addressing behavioral school readiness concerns.

Comparing the Reliability of Virtual and In-Person Post-Stroke Neuropsychological Assessment with Language Tasks.

Neuropsychological testing is essential for both clinical and basic stroke research; however, the in-person nature of this testing is a limitation. Virtual testing overcomes the hurdles of geographic location, mobility issues and permits social distancing, yet its validity has received relatively little investigation, particularly in comparison with in-person testing. We expand on our prior findings of virtual testing feasibility by assessing virtual versus in-person administration of language and communication tasks with 48 left-hemisphere stroke patients (21 F, 27 M; mean age = 63.4 ± 12; mean years of education = 15.3 ± 3.5) in a quasi-test-retest paradigm. Each participant completed two testing sessions: one in their home and one in the research lab. Participants were assigned to one of the eight groups, with the testing condition (fully in-person, partially virtual), order of home session (first, second) and technology (iPad, Windows tablet) varied across groups. Across six speech-language tasks that utilized varying response modalities and interfaces, we found no significant difference in performance between virtual and in-person testing. However, our results reveal key considerations for successful virtual administration of neuropsychological tests, including technology complications and disparities in internet access. Virtual administration of neuropsychological assessments demonstrates comparable reliability with in-person data collection involving stroke survivors, though technology issues must be taken into account.

Barriers to Long-acting Injectable Antipsychotic Adherence During the COVID-19 Pandemic: Observations From One Site.

Long-acting injectable antipsychotics (LAI-As) are a crucial treatment option for individuals with serious mental illness. However, due to the necessity of in-person administration of LAI-As, pandemics pose unique challenges for continuity of care in the population prescribed these medications. This project investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on LAI-A adherence at a Veterans Health Administration medical facility in the United States, as well as changes in LAI-A prescribing and administration practices during this period. Electronic health records were evaluated for 101 patients prescribed LAI-As. A subset of 13 patients also participated in an interview and rated subjective concerns about pandemic-related barriers to medication adherence. Pandemic-related barriers to LAI-A adherence and/or changes to LAI-A medications were documented in 33% of the patients. Within-subjects comparison of an adherence metric computed from electronic health record data further suggested a somewhat higher incidence of missed or delayed LAI-A doses during the pandemic compared with before the pandemic. In contrast, only 2 of the 13 patients interviewed anticipated that pandemic-related concerns would interfere with medication adherence. The results of this study suggest that LAI-A access and adherence can be disrupted by pandemics and other public health emergencies but this finding may not generalize to other sites. As patients may not foresee the potential for disruption, psychiatric service providers may need to assist in proactively problem-solving barriers to access. Improved preparedness and additional safeguards against pandemic-related disruptions to LAI-A access and adherence may help mitigate adverse outcomes in the future. Identifying patients at elevated risk for such disruptions may help support these efforts.

Online vs Face-to-Face Administration of Impulse Control Disorder Questionnaires in Parkinson Disease: Does Method Matter?

Social desirability bias, the tendency to underreport undesirable behaviors, may be one reason patients with Parkinson disease (PD) underreport symptoms of impulse control disorders (ICDs). We compared rates of ICD endorsement on questionnaires administered face-to-face and online in 60 patients with mild-to-moderate idiopathic PD. Participants also completed a self-report measure of social desirability. We found a significantly higher prevalence of any ICD based on online (56.7%) vs in-person (33.3%) administration. Significantly higher endorsement of items related to hypersexuality in men and compulsive eating and buying in women were found with online administration. Social desirability bias was positively correlated with ICD symptom endorsement across all items and subscales. The results highlight the importance of social context/setting and the need for sensitivity and discretion when screening for ICD symptoms. Although a higher level of symptom endorsement does not necessarily imply a greater level of accuracy, more work is needed to determine which method of administration is most accurate for clinical and research practice.

Phone Administration of the Western Ontario Shoulder Instability Index Is More Reliable Than Administration via Email.

The Western Ontario Shoulder Instability (WOSI) questionnaire is a 21-item questionnaire to evaluate quality of life in patients with shoulder instability. Completing the questionnaire is time-consuming because each item is evaluated on a visual analog scale. Telephone or email versions of the score are appealing alternatives to administering it during the standard in-person patient visit; however, their validity and reliability remain unknown. (1) Does the numerical scale (NS) version of the WOSI correlate with the original WOSI and Quick-DASH? (2) Do telephone and email administration of the NS-WOSI have good reliability and consistency? (3) Compared with the original WOSI form, does the NS form lead to faster completion for patients and quicker data extraction for researchers? Between 2014 and 2019, 50 patients with a documented history of shoulder dislocation with persistent symptomatic shoulder instability, whether anterior, posterior, or multidirectional; patients scheduled for surgery; and patients with traumatic or nontraumatic injuries were prospectively recruited from the outpatient clinic of two university hospitals acting as Level 1 trauma centers and sports traumatology tertiary referral centers. The median (IQR) age was 28 years (24 to 36), and 80% (40 of 50) were men. Most (52% [26 of 50]) patients had two to five lifetime shoulder dislocations. Validity of the NS-WOSI was assessed using the Pearson correlation coefficient during an in-person visit; the original WOSI questionnaire (or its previously validated French-language version), NS-WOSI, and Quick-DASH questionnaires were administered in a random order. After a minimum 7-day interval, 78% (39 of 50) of patients completed the phone interview, and 74% (37 of 50) of patients completed the email version of the NS-WOSI score to evaluate NS-WOSI's reliability using the intraclass correlation coefficient (ICC), which was interpreted as poor (< 0.5), moderate (0.50-0.75), strong (0.75-0.90), and very strong (> 0.90). The standard error of measurement (SEM) was used to evaluate variability around the true score, with a low value indicating a high reliability. The 95% minimal detectable change (MDC 95% ) was calculated to evaluate the minimal change in score that was not related to measurement errors. Lastly, the Cronbach alpha was used to assess internal consistency (intercorrelation strength), where a value > 0.70 was considered good. The time needed for the patient to complete the various versions and for researchers to extract data was recorded. The NS-WOSI score was very strongly correlated with the original WOSI score (r = 0.96 [95% confidence interval (CI) 0.93 to 0.98]; p < 0.001). Although telephone-acquired and email-acquired data for the NS-WOSI questionnaires were correlated with the NS-WOSI (telephone r = 0.91 [95% CI 0.83 to 0.95]; p < 0.001; email r = 0.84 [95% CI 0.71 to 0.91]; p < 0.001), the ICC was higher for telephone interviews (0.92 [95% CI 0.86 to 0.96] versus email 0.80 [95% CI 0.64 to 0.89]), indicating that although both had good reliability, the phone interview was more suitable. The phone interview was also preferable to email regarding SEM (3% [52 of 2100 points] versus 6% [132 of 2100 points]) and the MDC 95% (7% [144 of 2100 points] versus 17% [366 of 2100 points]). The 95% CI of the MDC acquired by email was superior to the reported minimum clinically important difference for the original WOSI (7% [152 of 2100 points]), meaning that an error of measurement could wrongly be interpreted as a clinically significant change in score. Internal consistency was deemed good, with a Cronbach alpha of 0.96 (95% CI 0.92 to 98) and 0.89 (95% CI 0.79 to 0.94) for NS-WOSI telephone and email, respectively. The time to complete the NS-WOSI was reduced compared with the original WOSI (221 ± 153 seconds versus 266 ± 146 seconds, mean difference -45 seconds [95% CI -72 to -12]; p = 0.009). Lastly, data extraction was faster (62 ± 15 seconds versus 209 ± 52 seconds, mean difference -147 seconds [95% CI -164 to -130]; p < 0.001) with the NS-WOSI than with the original WOSI. The NS-WOSI in person, by telephone, or by email is a valid, reliable, and timesaving alternative to the original WOSI questionnaire. However, the reliability of data acquisition by telephone interviews was superior to that of email. Given that there were no important differences in performance for the NS-WOSI, regardless of whether it was administered in person or by phone, we suggest that physicians use both interchangeably based on patient convenience. However, we do not recommend using the email version, especially for research purposes, since it was not as reliable when compared with in-person administration. The responsiveness of the modified NS-WOSI, as well as factors influencing response rates to phone interview, are questions that remain to be explored.

Early pregnancy anxiety during the COVID-19 pandemic: preliminary findings from the UCSF ASPIRE study

BackgroundAntenatal anxiety has been linked to adverse obstetric outcomes, including miscarriage and preterm birth. However, most studies investigating anxiety during pregnancy, particularly during the COVID-19 pandemic, have focused on symptoms during the second and third trimester. This study aims to describe the prevalence of anxiety symptoms early in pregnancy and identify predictors of early pregnancy anxiety during the COVID-19 pandemic.MethodsWe assessed baseline moderate-to-severe anxiety symptoms after enrollment in the UCSF ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) Prospective Cohort from May 2020 through February 2021. Pregnant persons < 10 weeks’ gestation completed questions regarding sociodemographic characteristics, obstetric/medical history, and pandemic-related experiences. Univariate and multivariate hierarchical logistic regression analyses determined predictors of moderate or severe anxiety symptoms (Generalized Anxiety Disorder-7 questionnaire score ≥ 10). All analyses performed with Statistical Analysis Software (SAS®) version 9.4.ResultsA total of 4,303 persons completed the questionnaire. The mean age of this nationwide sample was 33 years of age and 25.7% of participants received care through a fertility clinic. Over twelve percent of pregnant persons reported moderate-to-severe anxiety symptoms. In univariate analysis, less than a college education (p < 0.0001), a pre-existing history of anxiety (p < 0.0001), and a history of prior miscarriage (p = 0.0143) were strong predictors of moderate-to-severe anxiety symptoms. Conversely, having received care at a fertility center was protective (26.6% vs. 25.7%, p = 0.0009). COVID-19 related stressors including job loss, reduced work hours during the pandemic, inability to pay rent, very or extreme worry about COVID-19, and perceived stress were strongly predictive of anxiety in pregnancy (p < 0.0001). In the hierarchical logistic regression model, pre-existing history of anxiety remained associated with anxiety during pregnancy, while the significance of the effect of education was attenuated.Conclusion(s)Pre-existing history of anxiety and socioeconomic factors likely exacerbated the impact of pandemic-related stressors on early pregnancy anxiety symptoms during the COVID-19 pandemic. Despite on-going limitations for in-person prenatal care administration, continued emotional health support should remain an important focus for providers, particularly when caring for less privileged pregnant persons or those with a pre-existing history of anxiety.

Can the Rorschach be Administered Remotely? A Review of Options and a Pilot Study Using a Newly Developed R-PAS App

The ongoing COVID-19 pandemic has required psychologists to adopt measures like physical distancing and mask wearing, though other safety procedures such as travel restrictions or prohibitions on in-person practice and research have fostered the use of tele-health tools. In this article, we review options for using the Rorschach task via videoconference and provide preliminary data from using a new electronic app for remote R-PAS administration to determine whether the remote administration in an electronic form yields different information than in-person administration with the cards in hand. As a pilot study, our focus is on the “first factor” of all Rorschach scores, i.e., complexity. Data were collected from 60 adult Italian community volunteers, and statistical analyses evaluated the extent to which the average complexity score significantly departed from R-PAS normative expectations (SS = 100), accompanied by Bayesian likelihoods for supporting the null hypothesis. Results suggest that the general level of complexity shown by the test-takers when administered the Rorschach remotely with the new R-PAS app closely resembles that previously observed using “standard” in-person procedures. Tentative analyses of other R-PAS scores suggested normative departures that could be due to the effects of the app, testing at home, or responses to the pandemic. We offer recommendations for future research and discuss practical implications.

Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment

ObjectivesTo assess the reliability of using videoconference technology to remotely administer the Short Physical Performance Battery (SPPB), including the 5-time sit-to-stand (5XSTS) and usual 4-m walk (4mWT), and the Timed Up and Go (TUG) tests and agreement with in-person administration among adults with and without cancer. MethodsParticipants from two ongoing clinical exercise trials in cancer survivors, one that included partners without cancer, comprised the available sample (n = 176; mean age 62.5 ± 11.5 years.). Remote tests were administered on two separate days by either the same or a different assessor to determine intra-rater and inter-rater reliability, respectively. We also compared tests conducted remotely and in-person using the same assessor and the same participant. Intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI) were used for all comparisons, except for the SPPB score, which used Cohen's kappa and Krippendorf's alpha for intra- and inter-rater reliability, respectively. ResultsRemote assessment of the TUG test had excellent intra-rater reliability (0.98, 95% CI 0.93–0.99), inter-rater reliability (ICC = 0.96, 95% CI 0.90–0.99), and good agreement with in-person tests (ICC = 0.88, 95% CI 0.74–0.94). The 5XSTS and 4mWT showed excellent (ICC = 0.92, 95% CI 0.84–0.96) and good (ICC = 0.87, 95% CI 0.71–0.94) intra-rater reliability, respectively, but somewhat lower inter-rater reliability (5XSTS: ICC = 0.65, 95% CI 0.34–0.83 and 4mWT: ICC = 0.62, 95% CI 0.30–0.81). Remote 5XSTS had moderate agreement (ICC = 0.72, 95% CI 0.62–0.80) and 4mWT had poor agreement (ICC = 0.48, 95% CI -0.07-0.76) with in-person tests. ConclusionsRemote assessment of common physical function tests in older adults, including those who have cancer, is feasible and highly reliable when using the same assessor. TUG may be the most methodologically robust measure for remote assessment because it is also highly reliable when using different assessors and correlates strongly with in-person testing. Adapting administration of objective measures of physical function for the remote environment could significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.

Using Technology for the Efficient and Precise Assessment of Cognitive Skills in Countries with Limited Standardized Assessment Instruments: A Report on the Case of Saudi Arabia

In Saudi Arabia, the country’s progress toward appropriate and inclusive education programs for children with disabilities is still evolving. A crucial aspect of this evolution has been the development of a comprehensive assessment battery that covers a broad range of cognitive factors for the diagnosis of neurodevelopment disorders and other types of intellectual atypicalities, including giftedness. The Alif–Ya Assessment Battery consists of 47 subtests based on various theories of intelligence. Alif–Ya capitalizes on advanced technologies to enable its delivery either in person or remotely. Moreover, over half of Alif–Ya’s subtests are adaptive; items are selected for the test takers based on their previous responses. In this paper, we provide an overview of the Alif–Ya Assessment Battery, describe how it was designed to make the best use of the latest and best features of technology for the appropriate and accurate assessment of children and adolescents in the Kingdom of Saudi Arabia via remote or in-person administration, and present initial data collected with the battery.

Online Administration of the Test of Narrative Language-Second Edition: Psychometrics and Considerations for Remote Assessment.

Our aim was to evaluate the psychometric properties of the online administered format of the Test of Narrative Language-Second Edition (TNL-2; Gillam & Pearson, 2017), given the importance of assessing children's narrative ability and considerable absence of psychometric studies of spoken language assessments administered online. The TNL-2 was administered to 357 school-age children at risk for language and literacy difficulties as part of a randomized controlled trial, across three annual cohorts, at three time points (pretest, posttest, and 5-month follow-up). Cohort 3 students were tested using an online format at posttest and at follow-up. We compared the Cronbach's alpha internal consistency reliability of the TNL-2 online testing scores with in-person scores from TNL-2 normative data and Cohort 3 in-person testing at pretest, and interrater reliability for Cohort 3 across test points. In addition, we examined measurement invariance across test occasions and the criterion validity of the TNL-2, the latter based on its correlations with narrative sample measures (Mean Length of Utterance in words and the Monitoring Indicators of Scholarly Language rubric). Internal consistency reliability, interrater reliability, and measurement invariance analyses of the online and in-person administration of the TNL-2 yielded similar outcomes. The criterion validity of the TNL-2 was found to be good. TNL-2 psychometric properties from online administration were generally in the good range and were not significantly different from in-person testing. When administered online using standardized procedures, the TNL-2 is valid and reliable for use in assessing narrative language proficiency in school-age children at risk for language and learning difficulties.

A post pandemic roadmap toward remote assessment for neuromuscular disorders: limitations and opportunities

Recent advances in technology and expanding therapeutic opportunities in neuromuscular disorders has resulted in greater interest in and development of remote assessments. Over the past year, the rapid and abrupt COVID-19 shutdowns and stay-at-home orders imposed challenges to routine clinical management and clinical trials. As in-person services were severely limited, clinicians turned to remote assessments through telehealth to allow for continued care. Typically, disease-specific clinical outcome assessments (COAs) for neuromuscular disorders (NMD) are developed over many years through rigorous and iterative processes to fully understand their psychometric properties. While efforts were underway towards developing remote assessments for NMD before the pandemic, few if any were fully developed or validated. These included assessments of strength, respiratory function and patient-reported outcomes, as well as wearable technology and other devices to quantify physical activity and function. Without many choices, clinicians modified COAs for a virtual environment recognizing it was not yet known how they compared to standard in-person administration. Despite being able to quickly adapt to the demands of the COVID-19 pandemic, these experiences with remote assessments uncovered limitations and opportunities. It became clear that existing COAs required modifications for use in a virtual environment limiting the interpretation of the information gathered. Still, the opportunity for real-world evaluation and reduced patient burden were clear benefits to remote assessment and may provide a more robust understanding and characterization of disease impact in NMD. Hence, we propose a roadmap navigating an informed post-pandemic path toward development and implementation of safe and successful use of remote assessments for patients with NMD.

Large Scale Survey Research with Older Adults/Persons with Disabilities in a Public Health Crisis

Best practice for measuring quality improvement and consumer satisfaction of health and human services for older adults and people with disabilities relies on in-person survey administration. This poster highlights adaptation strategies undertaken across three large-scale evaluation studies of program/service delivery conducted during the COVID-19 pandemic, necessitating a departure from in-person techniques: 1) Integrated Satisfaction Measurement for the Program of All-Inclusive Care for the Elderly (I-SAT-PACE), 2) National Core Indicators- Aging and Disabilities/Intellectual and Developmental Disabilities (NCI-AD/IDD), and 3) Assisted Living Resident Quality of Life (AL-QOL). Data collection for these projects occurred from September 2020 to August 2021, providing an opportunity to showcase project adaptation over the course of the pandemic. Using project implementation examples across 15 states and approximately 10,100 participants, we discuss implications for successful survey coordination, interviewer training, data collection, and participant/stakeholder engagement during a public health emergency. Strategies included pivoting to phone, Zoom, and paper-based data collection and increasing technical assistance for field staff and participants. Project teams were able to increase access to participation by implementing multimodal survey delivery, mitigate coronavirus exposure, continue collecting older adults and people with disabilities’ experiences, and compare results based on method of delivery. Technology barriers, field staff dropout, need for larger sample sizes, and inclusion of participants with dementia, hearing, and speech impairments present important tradeoffs to consider. These examples indicate it is possible to administer hybrid data collection methods across populations with varying cognitive and physical abilities without compromising data quality.

Virtual Testing of Seniors: The Feasibility of Research with Online Neuropsychological Tests (FRONT)

Synergic@Home is a feasibility study evaluating the effects of exercise and cognitive interventions for the prevention of dementia in at-risk individuals over age 60. The COVID-19 pandemic changed the study’s methods, with standardized neuropsychological tests needing to be administered virtually. Experience and research into the viability of neuropsychological assessments administered virtually is limited. After receiving permission to adapt the tests for virtual administration, a neuropsychologist, project managers, and research coordinators developed their approach. A PowerPoint presentation using text and visual stimuli from the tests was developed with on-screen instructions for the raters. An iterative development process involved feedback from the team in order to maximize the fidelity of these methods compared to in-person administration. Mock assessments supervised by a neuropsychologist further refined the methods and confirmed rater adherence to standardized procedures. A secure videoconferencing platform meeting privacy requirements was used. Dual monitors for the raters provided instructions on one monitor while stimuli for the participant was on the second monitor. The participant could only see the stimuli. This method of administering neuropsychological assessment, the Feasibility of Research with Online Neuropsychological Testing (FRONT), is being used to evaluate older adult participants in Synergic@Home. Results from this feasibility study may set the stage for new research methodologies and/or clinical evaluations in the future. This project is funded by the New Brunswick Healthy Seniors Pilot Project and the Canadian Consortium on Neurodegeneration in Aging (with grants from Public Health Agency of Canada and the Canadian Institutes of Health Research, with additional funding partners).

The Scope of Rape Victimization and Perpetration Among National Samples of College Students Across 30 years.

Research Questions: Rape prevention practice and policy have roots in data from 1985. This study uses 2015 national data to project recent prevalence, assesses whether rates now differ from those of 30 years ago, and disaggregates 2015 prevalence into rape of alcohol incapacitated victims, rapes combining both alcohol and physical tactics, and violent rape. Methods: Cross-sectional analyses were conducted comparing two national samples. The first was collected in 1984-85 (Koss, Gidycz, & Wisniewski, 1987); the second was collected 30 years later in 2014-2015. Both surveys used in-person administration and measurement by the most current version at the time of the Sexual Experiences Survey (SES). Prevalence rates were compared using Bayesian binomial tests. Results: In 2015, 33.4% (1 in 3) of women reported experiencing rape or attempted rape and 12.7% of men reported perpetration (1 in 8). Using Jeffreys' label for effect size of the Bayes binomial (1961), both results are "decisively" greater than expected given the 1985 benchmarks of 27.9% for victimization and 7.7% for perpetration. Victimization when incapacitated characterized approximately 75% of incidents in 2015 up from 50% in 1985. Cautions apply as cross-sectional data does not establish causality and the recent data set involved the revised SES. Conclusions: Across 30 years, neither containment nor reduction of rape was demonstrated and the increasingly prominent association with alcohol was apparent. Among the men who disclosed raping, 9 of 10 incidents were alcohol-involved. Prevention focus might profitably be directed to constraining alcohol environments and policies that facilitate rape of incapacitated persons and on misconduct responses that are proportional to the harm caused to rape victims, thereby raising the perceived risks of perpetration.

Leveraging videoconferencing supports the continuity of Alzheimer research during the COVID‐19 pandemic and beyond

BackgroundThe COVID‐19 pandemic has placed a demand on researchers to limit in‐person contact with participants, greatly impacting Alzheimer Disease (AD) research. To address this problem, we describe here an approach to using digital technology to continue nationwide clinical recruitment and ascertainment of biological samples while adhering to COVID‐19 guidelines and travel restrictions.MethodTo accomplish this, we considered a videoconferencing approach for remote delivery of cognitive assessments. A multi‐site panel of neurologists and clinical psychologists and a detailed literature review ensured a protocol that captures the best‐practices for administering assessments through videoconferencing while ensuring consistency between remote and in‐person administration. Clinical coordinators underwent training to ensure good agreement with in‐person administration. Most aspects of the cognitive assessments easily transferred to videoconferencing, though Trail Making A and B, and Digit Symbol‐Coding were removed to protect the integrity of the evaluation. Additionally, we coordinated the collection of biological samples with a national company, Quest Diagnostics, to provide phlebotomy services at the participant’s residence. All protocols were developed under the guidance of the Human Subjects Research Office at the University of Miami and with approval of local IRB.ResultOur clinical coordinators completed over two dozen remote assessments using these protocols. Both cases and controls were enrolled, across various ethnic populations within our study. The distributions of age and 3MS were similar between in‐person and remote assessments. The uptake of videoconferencing enrollment varied among the age groups, level of impairment, at‐home support system and telemedicine readiness. For example, earlier‐onset groups had the best uptake, while older‐onset groups showed the least uptake due to a higher prevalence of telemedicine unreadiness (Lam et al., 2020; Bossen et al.,2015).ConclusionThis study demonstrates that remote enrollment and ascertainment of biological samples through videoconferencing and partnering with national mobile phlebotomy services is feasible. This approach allows researchers to continue ascertainment efforts while maintaining their participants’ autonomy through informed consent and privacy throughout the process and minimizing their exposure to COVID‐19.

Do PROs Tell the Whole Story? Differential Outcomes Based on Patient-Reported Outcomes (PROs) Versus Performance-Based Metrics (PBM) on Cognition for Patients Receiving Chimeric Antigen Receptor (CAR)-T Cell Therapy

Do PROs Tell the Whole Story? Differential Outcomes Based on Patient-Reported Outcomes (PROs) Versus Performance-Based Metrics (PBM) on Cognition for Patients Receiving Chimeric Antigen Receptor (CAR)-T Cell Therapy