Investigation of the Validity and Reliability of the Tele-Assessment of Balance andMental Status in Individuals with Stroke

Objective: With tele-rehabilitation increasingly becoming a commonly preferred approach, it has gained importance to investigate whether assessment scales traditionally used in face- to-face settings are valid and reliable when applied via tele-assessment, in order to ensure the remote and long-term sustainability of rehabilitation processes. The aim of this study was to investigate the validity and reliability of the tele-assessment of balance and mental status in individuals with stroke using the Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), Mini-BESTest, Montreal Cognitive Assessment (MoCA), Tandem Flamingo Test, and Romberg Stance Test. Methods: A total of 20 individuals with stroke were included in the study, with a mean age of 54.85 ± 15.42 years; 16 were male (80%) and 4 were female (20%). All participants were at stage 3 or higher for both upper and lower extremities according to the Brunnstrom staging system. The order of assessments (tele- assessment first or face-to-face assessment first) and the allocation of the two physiotherapists conducting the assessments were randomized based on the order of application. The BBS, MMSE, MoCA, Mini-BESTest, Tandem Flamingo Test, and Romberg Stance Test were administered to the participants using both tele-assessment and face-to- face assessment methods. Video recordings were obtained during tele-assessment, and a third evaluation was performed three weeks later by the same physiotherapists using these recordings. Results: Excellent agreement was observed between tele-assessment and face- to-face assessment, as well as between face-to-face assessment and video-based evaluation, for the MoCA, MMSE (excluding the orientation subscale), BBS, Mini BESTest, and the Tandem-Flamingo and Romberg Stance Tests (ICC> 0.90). For the orientation subscale of the MMSE, good agreement was found (0.894). Additionally, asynchronous tele-assessment conducted via video recordings three weeks later demonstrated excellent agreement with both face-to-face assessment and synchronous tele-assessment (ICC> 0.90). Conclusion: The findings indicate that the BBS, MMSE, Mini-BESTest, MoCA, Tandem Flamingo Test, and Romberg Stance Test are valid and reliable tools for the tele-assessment of balance and mental status in individuals with stroke. However, it is recommended that greater caution be exercised when conducting measurements using single-task and time-based tests, such as the Tandem Flamingo and Romberg Stance Tests, during tele-assessment.