Telemedicine: Inter-Method Agreement Between In-Person Consultations and Video Recordings When Diagnosing Benign Paroxysmal Positional Vertigo

<b>Objective:</b> To investigate the inter-method agreement between in-person consultations and video recordings when diagnosing BPPV. <b>Methods:</b> Two experienced vestibular clinicians (clinician A and B) evaluated patients for the presence and type of BPPV, using the TRV chair (Interacoustics, Middlefart, DK), at a tertiary referral center. During these in-person consultations, diagnostic maneuvers and eye movements were recorded, and a diagnosis was made. Both clinicians independently evaluated their cases again, during two video review sessions (Video Review 1 and Video Review 2). These sessions were conducted one month apart. Both clinicians were blinded to patient information and medical history during the analysis and did not have access to sound recordings. They were asked to provide a new diagnosis, based on the videos alone. Inter-method and intra-observer agreement for BPPV diagnoses between in-person consultations and video reviews were assessed using the percentage of agreement and Cohen's kappa. An independent analysis of all patients' eye movements was conducted to identify patterns that might have influenced agreement between in-person consultation diagnoses and the two video reviews by clinicians. <b>Results:</b> During the in-person consultations, each clinician evaluated 100 patients. Clinician A diagnosed BPPV in 40% of the cases, while clinician B diagnosed it in 19% of the cases. Considering the inter-method agreement, clinician A agreed on 81% (95% CI (73, 89)) and 77% (95% CI (69, 85)) of the cases with associated kappa coefficients of 0.67 (95% CI (0.55, 0.79)) and 0.63 (95% CI (0.51, 0.75)) between in-person consultations and Video Reviews 1 and 2, respectively. For clinician B, the percentages of agreement were, respectively, 86% (95% CI (79, 93)) and 84% (95% CI (77, 91)), with corresponding kappa coefficients of 0.55 (95% CI (0.36, 0.74)) and 0.51 (95% CI (0.32, 0.70)). As for the intra-observer agreement, clinician A achieved an intra-observer agreement of 84% (95% CI (77, 91)) with kappa = 0.74 (95% CI (0.63, 0.85)), while clinician B achieved a slightly higher intra-observer agreement of 90% (95% CI (84, 96)) with kappa = 0.67 (95% CI (0.51, 0.83)). Descriptive analysis of the eye movement revealed that both clinicians showed high diagnostic consistency for "no BPPV" in cases without provoked nystagmus (78/86, 91%) even when spontaneous nystagmus was present, and for posterior canal BPPV (37/78, 47%) when characteristic nystagmus was observed. However, disagreement was noted for horizontal canal BPPV (15 cases) and in scenarios with subjective BPPV (2 cases) or purely vertical nystagmus (11/31 cases, 35%). <b>Conclusions:</b> This study showed the feasibility of using video recordings when diagnosing BPPV. It demonstrates that BPPV might be reliably diagnosed in a telemedicine setting. However, careful consideration must be given to certain factors during the protocol's design to improve the diagnostic process.