Teleneuropsychology in the COVID-19 Pandemic: Developing and testing the convergent validity of the eSPANS

Emergency restrictions implemented as a result of the COVID-19 pandemic have required many health services to rethink how care is delivered, including neuropsychology. The advantages of Teleneuropsychology (TeleNP), remote delivery of neuropsychology assessment via video teleconferencing (VTC), have become substantially more prominent. This thesis aimed to evaluate the latest evidence of VTC assessment validity, feasibility and acceptability in order to design and trial remote administration of the Short Parallel Assessments of Neuropsychological Status (SPANS).

Literature Review:

A systematic and comprehensive search of the TeleNP literature in three peer-reviewed databases and extensive grey literature sources produced 52 items for review. VTC assessment was largely found to be feasible and valid, with high levels of equivalency when compared to face-to-face (FTF) versions. Screening tools or neuropsychological tests of attention, memory and language produced the strongest results, with executive function and visuospatial measures showing more variation. High levels of acceptability were often noted from clients, with neuropsychology clinicians often hesitant to adopt TeleNP practises, but an increase in available guidance looking to improve uptake.

Empirical Study:

The SPANS required adjustments to be administered via VTC, but was designed to simulate the FTF version closely. This new eSPANS was administered to 42 healthy adults aged 18-59 and compared to existing FTF normative data (n=255). The eSPANS was usable and well accepted in this population, with a majority suggesting a preference over FTF testing. Recommendations are made to eliminate technical difficulties that resulted in significantly worse scores on one specific subtest. Elsewhere performance was equivalent or significantly better than normative FTF data. Improved performance may be a result of sampling bias or an increased comfort level. Equivalency can therefore not yet be concluded. The perils of working with homogenous, skewed distributions with high kurtosis are discussed and steps for future highly-powered normative research are recommended.