Through the Looking Glass: Remote Versus In-Person Videotaped Neurologic Assessment of Essential Tremor

Abstract

Background: Remote assessment of essential tremor (ET) is unverified. Objectives: To compare assigned tremor scores from a remote videotaped research protocol with those from an in-person videotaped research protocol and assess the validity of remote and in-person videotape-based diagnoses when compared against the intake diagnosis (ET vs. control). Methods: Participants with intake diagnoses of ET (11) or controls (15) completed a tremor examination that was filmed both remotely and in person. Results: Agreement between the tremor ratings assigned during remote and in-person videos was substantial (composite κw, 0.67; mean Gwet's AC2 score, 0.92; mean percent agreement, 63.7%). In ET cases with less severe tremor, agreement was lower (p = 0.008). Diagnostic validity was high for both remote and in-person videos compared to the intake diagnosis. Conclusions: Remote video is a reasonable alternative to in-person video for the assessment of tremor severity and assignment of ET diagnoses. However, at low tremor amplitudes, agreement declines.