Validity of the remote evaluation of NIH Stroke Scale, modified Rankin Scale and Barthel Index using a tablet device (iPad^®).

Abstract

Background and purpose: Consistency between face-to-face and remote examination ratings has not been clarified for the NIH Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS). We aimed to demonstrate the reliability of NIHSS, BI and mRS assessments via a telestroke system using a tablet device. Methods: Two neurologists assessed 16 stroke patients using NIHSS, mRS and BI scores by both face-to-face and remote examinations. Weighted κ coefficients were used as a measure of consistency between face-to-face and telestroke ratings for each outcome scale. Cronbach’s α was used as a measure of reliability, and intraclass correlation coefficient (ICC) was used as a measure of concordance for total and individual NIHSS, BI and mRS scores between face-to-face and telemedicine-based evaluations. Results: In terms of the weighted κ coefficient, consistency between face-to-face and telestroke ratings for NIHSS, BI and mRS were 0.82, 0.88 and 0.77, respectively. Agreement of total scores for these three scales as assessed by two different methods were evaluated as ‘almost perfect’ by Cronbach’s α and ICC. Conclusion: Remote assessment of NIHSS, BI and mRS using an interactive video conferencing system equipped with a tablet device is feasible and as reliable as face-to-face evaluations, offering high reliability and consistency.