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Teleneuropsicologia : fiabilidade e aceitação em provas de memória
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Introdução: O recurso ao teleatendimento em intervenções psicológicas experimentou, nos últimos anos, um grande incremento. Esta forma de contacto com o paciente traz implicações a considerar, nomeadamente, em avaliação neuropsicológica. Assim, a fiabilidade das provas neuropsicológicas neste formato, bem como a sua aceitação, devem ser estudadas. Em contexto neuropsicológico, são várias as situações em que existe necessidade de acompanhar e reavaliar as pessoas ao longo do tempo, em particular na área do envelhecimento. A avaliação repetida ao longo do tempo pode ter a sua validade diminuída pelo que se recomendam versões alternativas dos testes de avaliação. A possibilidade de avaliações e reavaliações em formatos presenciais e com recurso a meios online de comunicação à distância, gera a necessidade de instrumentos com versões alternativas com boa fiabilidade para aplicação por teleatendimento. Todavia, em Portugal, estão publicados poucos estudos quer relativos à fiabilidade e aceitação do teleatendimento, quer a versões alternativas dos instrumentos de avaliação neuropsicológica mais utilizados. Estudo 1: Metodologia: Desenvolveram-se duas histórias comparáveis com as duas mais usadas a nível estrutural e paridade de conteúdo que foram posteriormente avaliadas por um grupo de peritos. Foi realizado um pré-teste para criar critérios de cotação provisórios. As duas histórias em uso e as duas novas foram aplicadas a 80 adultos sem suspeita de deterioração cognitiva. Resultados: As novas histórias têm valores de consistência interna aceitáveis. Os resultados demonstraram correlações positivas moderadas entre os parágrafos originais e os das versões alternativas. Foram encontradas diferenças significativas entre os resultados de desempenho nas histórias alternativas e as histórias homólogas, nos dois momentos de evocação. Conclusão: As correlações obtidas indiciam que as novas histórias podem ser uma alternativa válida à versão original, nos casos em que é necessária uma reavaliação. Dadas as diferenças em termos de pontuação, não devem ser comparados diretamente resultados das histórias originais e das histórias alternativas devendo as novas histórias ser validadas para a população portuguesa, para a obtenção de valores normativos. Estudo 2: Metodologia: A amostra consistiu em 44 adultos sem suspeita de deterioração cognitiva. Realizaram uma sessão presencial e outra por videoconferência, nas quais se aplicaram provas de memória verbal e outras medidas cognitivas, questionários de caracterização (dados sociodemográficos, queixas de memória e literacia informática), de funcionalidade, sintomatologia depressiva e satisfação da teleconsulta. Resultados: Os resultados não revelam diferenças significativas entre os desempenhos das provas de memória verbal nas duas condições. A satisfação da teleconsulta foi elevada, mas não correspondeu a uma maior preferência por este modo. Conclusão: A avaliação neuropsicológica da memória episódica auditivo verbal através de teleatendimento é viável e bem aceite pela população mais velha portuguesa e os dados apontam no sentido de os resultados obtidos serem fiáveis como medida de memória episódica.
Background: The use of telehealth in psychological interventions has experienced a large increase in recent years. This form of contact with the patient has implications to consider, especially in neuropsychological assessment. Therefore, the reliability of neuropsychological tests in this format, as well as their acceptance, must be studied. In neuropsychology, there are several situations in which there is a need to monitor and re-evaluate people over time, particularly in regards aging. Repeated assessments over time may decrease their validity, thereby, alternative versions of assessment tests are recommended. The possibility of assessments and reassessments in face-to-face formats and with the use of online communication technologies, generates the need for instruments with alternative versions with good reliability for online application. However, in Portugal, few studies have been published either regarding the reliability and acceptance of telehealth or alternative versions of the most used neuropsychological assessment instruments. Study 1: Methodology: Two stories comparable to the two most used in terms of structure and content parity were developed and were subsequently evaluated by a group of experts. A pre-test was carried out to create provisional quoting criteria. The two stories in use and the two new ones were applied to 80 adults without suspected cognitive deterioration. Results: New stories have acceptable internal consistency values. The results demonstrated moderate positive correlations between the original paragraphs and those in the alternative versions. There were also found significant differences between the performance results in the alternative stories and the original ones, in the two moments of recall. Conclusion: The correlations obtained indicate that the new stories can be a valid alternative to the original version, in cases where a re-evaluation is needed. Given the differences in terms of scoring, results from the original stories and alternative stories should not be directly compared. The new stories should also be validated for the Portuguese population, to obtain normative values. Study 2: Methodology: The sample consisted of 44 adults without suspected cognitive deterioration. They were assessed by cognitive measures and questionnaires (sociodemographic data, memory complaints and computer literacy), functionality, depressive symptoms and satisfaction with the teleconsultation using videoconference and in-person approaches. Results: The results do not reveal significant differences between the performances of the verbal memory tests in the two conditions. Teleconsultation satisfaction was high but did not translate to a greater preference for this option. Conclusion: The neuropsychological assessment of auditory-verbal episodic memory through telehealth is viable and well accepted by the older Portuguese population and the data indicates that the obtained results are reliable as a measure of episodic memory.
Background: The use of telehealth in psychological interventions has experienced a large increase in recent years. This form of contact with the patient has implications to consider, especially in neuropsychological assessment. Therefore, the reliability of neuropsychological tests in this format, as well as their acceptance, must be studied. In neuropsychology, there are several situations in which there is a need to monitor and re-evaluate people over time, particularly in regards aging. Repeated assessments over time may decrease their validity, thereby, alternative versions of assessment tests are recommended. The possibility of assessments and reassessments in face-to-face formats and with the use of online communication technologies, generates the need for instruments with alternative versions with good reliability for online application. However, in Portugal, few studies have been published either regarding the reliability and acceptance of telehealth or alternative versions of the most used neuropsychological assessment instruments. Study 1: Methodology: Two stories comparable to the two most used in terms of structure and content parity were developed and were subsequently evaluated by a group of experts. A pre-test was carried out to create provisional quoting criteria. The two stories in use and the two new ones were applied to 80 adults without suspected cognitive deterioration. Results: New stories have acceptable internal consistency values. The results demonstrated moderate positive correlations between the original paragraphs and those in the alternative versions. There were also found significant differences between the performance results in the alternative stories and the original ones, in the two moments of recall. Conclusion: The correlations obtained indicate that the new stories can be a valid alternative to the original version, in cases where a re-evaluation is needed. Given the differences in terms of scoring, results from the original stories and alternative stories should not be directly compared. The new stories should also be validated for the Portuguese population, to obtain normative values. Study 2: Methodology: The sample consisted of 44 adults without suspected cognitive deterioration. They were assessed by cognitive measures and questionnaires (sociodemographic data, memory complaints and computer literacy), functionality, depressive symptoms and satisfaction with the teleconsultation using videoconference and in-person approaches. Results: The results do not reveal significant differences between the performances of the verbal memory tests in the two conditions. Teleconsultation satisfaction was high but did not translate to a greater preference for this option. Conclusion: The neuropsychological assessment of auditory-verbal episodic memory through telehealth is viable and well accepted by the older Portuguese population and the data indicates that the obtained results are reliable as a measure of episodic memory.
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Keywords
Telessaúde Memória episódica Versões alternativas Avaliação neuropsicológica Telehealth Episodic memory Alternative versions Neuropsychological assessment