Assessment Validation

评估验证

• 批准号: 10766041
• 负责人: JAMES P O'HALLORAN
• 金额: $ 26.6万
• 依托单位: NEUROCOMP SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10766041
• 关键词: Address; Advisory Committees; Agreement; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease test; Android; Architecture; Authorization documentation; Behavior assessment; COVID-19; Certification; Clinical; Clinical Trials; Clinical assessments; Communication; Data; Databases; Devices; Diagnosis; Disease; Distal; Elderly; Electronics; Evaluation; Exposure to; Goals; Health Services Accessibility; Home; Human; Hybrids; Impaired cognition; Infrastructure; Instruction; Internet; Language; Manuals; Modality; Monitor; Mus; Natural Language Processing; Neurocognitive; Operating System; Paper; Participant; Patients; Perception; Persons; Phase; Population; Portal System; Procedures; Process; Recommendation; Reference Standards; Reporting; Research; Risk Reduction; Sample Size; Sampling; Services; Site; Specific qualifier value; System; Technology Assessment; Telephone; Testing; Touch sensation; Trail Making Test; Training Activity; Travel; Underserved Population; Validation; Variant; Voice; authority; behavior test; clinical center; cognitive function; computerized; cost; dashboard; data management; design; digital; follow-up; indexing; instrument; mobile computing; neurocognitive test; next generation; nonEnglish language; patient response; peer; phase 1 testing; prototype; remote administration; remote assessment; research clinical testing; research study; response; software development; symposium; telephone based; usability; verbal; virtual

Numerous exploratory research studies over the past decade have demonstrated good to excellent agreement of remote neurocognitive assessment (rNCA) compared to paper-based Face-to-Face (p-FTF) by both televideo and telephonic modalities. Studies in samples of elderly subjects with Alzheimer’s disease and related dementias reported similar results. Rationale for rNCA include addressing the needs of underserved populations, reducing risk of exposure to infective disorders such as COVID-19 and variants, rapid care access, and minimizing travel burden to clinical centers. Currently, televideo-based rNCA is implemented using conferencing devices and services with a “remote” examiner entering patient responses onto paper forms. Tests requiring graphical entry pose complications. Telephonically-based rNCA enables in-home assessment and longitudinal tracking and follow up but is similarly dependent on paper-based data capture and associated manual processing. A purpose-designed Computerized Assessment by Remote Examiner System (CARES) is proposed that will enable unified, end-to-end rNCA assessment and management based on an enterprise-level, next-generation hybrid REACT NATIVE (hRN) architecture. CARES will host computerized versions of reference standard neurocognitive and behavioral tests widely applied in the clinical identification and assessment of MCI and Alzheimer’s disease and for controlled trials and wide-ranging research. Televideo-based assessments will be performed by a remote “Virtual Examiner” approach, enabling administration as if seated adjacent to a patient or research participant. At the start of a session and between tests, a Remote Examiner (R-Ex) and a participant will be able to see and converse with each other in full screen mode, establishing and maintaining rapport. At a participant-hosting site, the system will be comprised of a Windows 10-11 PC and an ultrathin 15.6” touch-sensitive secondary monitor (e.g., ViewSonic TD1655) enabling graphical stylus entry for commonly applied tests such as Clock Drawing and Trail Making. CARES has been designed to accommodate the elderly and those with cognitive impairments by closely integrating the R-Ex who will be able to 1) control the mouse and keyboard on the site’s PC, entering responses, 2) control session pace, 3) repeat and supplement digitized (human voice) instructions, and 4) immediately score responses (e.g., verbal report), and 5) pause or terminate a test. These capabilities will be enabled by integrated, application-specific Remote Desktop Control (RDC) operability and screen sharing. Application-integrated web connectivity will be implemented by a proprietary peer-to-peer WebRTC communication layer. The multiplatform CARES will support assessment across televideo, telephonic, and (computerized) in-person modalities and across operating systems (Windows, iOS, Android). In Phase I, the system will be evaluated at two established Alzheimer’s centers to estimate concurrent validity, reliability, and acceptability of CARES computerized versions vs. p-FTF versions in a set of neurocognitive tests commonly applied in the evaluation of Alzheimer’s disease and related dementias. CARES represents a fundamental advance in operationalizing rNCA.

在过去的十年中，许多探索性的研究已经证明了远程神经认知评估（rNCA）与基于纸张的面对面（p-FTF）的电视和电话模式相比具有良好的一致性。对阿尔茨海默病和相关痴呆症老年受试者样本的研究报告了类似的结果。rNCA的基本原理包括满足服务不足人群的需求，降低暴露于感染性疾病（如COVID-19及其变体）的风险，快速获得护理，以及最大限度地减少前往临床中心的旅行负担。目前，基于电视的rNCA是使用会议设备和服务来实现的，其中“远程”检查者将患者的反应输入到纸质表格上。需要图形输入的测试会带来复杂性。基于电话的rNCA能够进行家庭评估和纵向跟踪和随访，但同样依赖于基于纸张的数据采集和相关的手动处理。 提出了一种专门设计的远程考官系统（CARES）计算机化评估，该系统将基于企业级下一代混合REACT NATIVE（hRN）架构实现统一的端到端rNCA评估和管理。CARES将主持参考标准神经认知和行为测试的计算机化版本，这些测试广泛应用于MCI和阿尔茨海默病的临床鉴定和评估以及对照试验和广泛的研究。基于电视的评估将通过远程“虚拟检查员”方法进行，使管理就像坐在患者或研究参与者旁边一样。在会话开始时和测试之间，远程检查员（R-Ex）和参与者将能够在全屏模式下相互查看和匡威，建立并保持融洽的关系。在参与者托管站点，该系统将由一台Windows 10-11 PC和一台15.6”触摸感应辅助显示器（例如，ViewSonic TD 1655），支持常用测试（如时钟绘图和轨迹制作）的图形手写笔输入。CARES旨在通过紧密集成R-Ex来适应老年人和认知障碍者，R-Ex将能够1）控制站点PC上的鼠标和键盘，输入响应，2）控制会话速度，3）重复和补充数字化（人声）指令，以及4）立即对响应进行评分（例如，口头报告），以及5）暂停或终止测试。这些功能将通过集成的、特定于应用程序的远程桌面控制（RDC）可操作性和屏幕共享来实现。应用程序集成的Web连接将通过专有的对等WebRTC通信层实现。多平台CARES将支持跨电视视频、电话和（计算机化）面对面模式以及跨操作系统（Windows、iOS、Android）的评估。在第一阶段，该系统将在两个已建立的阿尔茨海默病中心进行评估，以估计CARES计算机化版本与p-FTF版本在一组通常用于评估阿尔茨海默病和相关痴呆的神经认知测试中的并行有效性、可靠性和可接受性。CARES是在实施rNCA方面取得的根本性进展。