Validating telehealth assessment of physical concussion symptoms
Clinical Snapshot
PICO Framework
| P — Population | Adults with concussion (n=16) and healthy controls (n=20) recruited through a rehabilitation research centre in Melbourne, Australia |
| I — Intervention | Telehealth-adapted assessment of vestibular, oculomotor, cervical, and autonomic function delivered remotely via videoconferencing |
| C — Comparator | Standard in-person physical concussion assessment using the same battery of measures |
| O — Outcomes | Feasibility (completion rates, technical issues, adverse events, administration time, clinician usability ratings) and concurrent validity (percentage agreement, Cohen's kappa, sensitivity, specificity) of telehealth versus in-person assessment |
Bottom Line
This small Australian validation study (n=36) provides preliminary evidence that telehealth-adapted physical concussion assessment is feasible and shows reasonable agreement with in-person assessment across vestibular, ocular convergence, cervical range of motion, and autonomic domains. Clinicians reported high usability and shorter administration times. However, the study's very small sample size substantially limits the precision of all validity estimates, and the specialist rehabilitation recruitment context may not reflect primary care or rural telehealth populations. Blinding between assessment modalities is not explicitly described, raising concern about review bias. Smooth pursuit assessment and autonomic function protocols require further refinement. The findings are encouraging for Australian physiotherapists seeking to expand telehealth concussion services — particularly relevant given MBS telehealth provisions — but should be interpreted as hypothesis-generating rather than practice-changing. Replication in larger, more diverse samples with explicit blinding protocols, reported confidence intervals, and downstream clinical utility outcomes is essential before telehealth physical concussion assessment can be recommended as equivalent to in-person evaluation in clinical guidelines.
Key Findings
P Value: Not reported in abstract
Effect Size: High agreement and sensitivity reported for vestibular, ocular convergence, autonomic, and cervical range of motion measures; lower agreement for ocular smooth pursuits. Specific kappa and sensitivity/specificity values not reported in abstract.
Primary Outcome: Concurrent validity (agreement between telehealth and in-person physical concussion assessment) across vestibular, oculomotor, cervical, and autonomic domains, plus feasibility metrics
Nnt Or Sensitivity: Sensitivity reported as high for most domains (specific values not available in abstract); specificity values not quantified in abstract. Cohen's kappa used as primary agreement statistic. Smooth pursuits showed notably lower agreement — specific kappa value not reported.
Confidence Interval: Not reported in abstract; given n=36 total, confidence intervals for sensitivity and specificity estimates would be expected to be wide (likely ±15–25 percentage points)
Clinical Application
Telehealth delivery appears feasible based on high completion rates, minimal technical issues, no adverse events, shorter administration times, and high clinician-rated usability. However, feasibility in resource-limited settings (rural/remote, low bandwidth, older patients) has not been evaluated. Equipment requirements for adequate video quality to assess oculomotor function remotely need clarification. This study is directly relevant to Australian practice. Telehealth has been significantly expanded under Medicare Benefits Schedule (MBS) telehealth items introduced during and sustained after the COVID-19 pandemic, including items applicable to physiotherapy and allied health concussion management. The RACGP and Australasian College of Sport and Exercise Physicians (ACSEP) both recognise multidisciplinary concussion assessment. The Monash-Epworth setting reflects Australian specialist rehabilitation practice. For rural and remote Australians — who face significant barriers to specialist concussion care — validated telehealth assessment protocols could meaningfully improve access. TGA considerations are not directly applicable as no device or therapeutic product is under evaluation. PBS considerations are not applicable. The findings support the case for MBS-funded telehealth physiotherapy assessment of concussion, though larger validation studies are needed before formal guideline endorsement. Adults with concussion being assessed by physiotherapists or rehabilitation clinicians in telehealth settings, particularly those with vestibular, oculomotor, cervical, or autonomic symptoms. Most directly applicable to subacute concussion in specialist rehabilitation contexts.
Abstract
BACKGROUND: Telehealth could expand access to specialised concussion care; however, physiotherapists report low confidence in assessing physical symptoms remotely. This study adapted measures of vestibular, oculomotor, cervical and autonomic function for telehealth delivery, and evaluated their feasibility and comparability with in-person assessment. METHODS: Using a repeated-measures design, 16 participants with concussion and 20 controls completed assessment modalities in random order (3 × 4 block randomisation). Feasibility was evaluated through completion rates, technical issues, adverse events and clinician feedback. Concurrent validity was examined using percentage agreement, Cohen's kappa, and sensitivity and specificity analyses. RESULTS: Telehealth assessment was feasible; most concussion participants and all controls completed the protocols, there were minimal technical issues, no adverse events and shorter administration times. Clinicians reported high usability and efficiency. High agreement and sensitivity were observed across vestibular, ocular convergence, autonomic and cervical range of motion measures. Nuanced assessment of ocular smooth pursuits showed lower agreement, and a potential ceiling effect on autonomic assessment was identified. CONCLUSION: This study preliminarily supports the feasibility and comparability of telehealth compared with in-person physical concussion assessments. Assessment of smooth pursuits and autonomic function require protocol refinement to enhance accuracy. Replication in larger samples is required to establish comparability.
References
- 1.Macheras, S., Peverill, T., McKay, A., Ponsford, J., Russell, T., & Davies, K. (2026). Validating telehealth assessment of physical concussion symptoms. Brain Impairment: A Multidisciplinary Journal of the Australian Society for the Study of Brain Impairment. https://doi.org/10.1071/IB25133
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