Self-Administered Mobile Cognitive Assessments for Individuals With Stroke: A Feasibility and Validation Study.

OBJECTIVE

To examine the feasibility, learning effects, stability, and validity of mobile cognitive assessments (MCAs) among individuals with stroke.

DESIGN

Longitudinal observational study using frequent, brief, repeated, in vivo self-administered mobile assessments of cognitive functions.

SETTING

Everyday life settings.

PARTICIPANTS

Twenty participants with mild-to-moderate stroke (mean age, 55.5y; 60% men; 45% Whites; 70% ischemic stroke).

INTERVENTION: Not applicable.

MAIN OUTCOME MEASURES: Over 14 days, participants used smartphones to complete a digital assessment protocol. The protocol included 6 ecological momentary assessment surveys on self-reported health status, along with 4 MCAs, each administered twice daily. MCAs included the Mobile Stroop Color Word Test (M-SCWT), Mobile Spatial Memory Test Forward and Backward, Mobile Trail Making Test Parts A and B (M-TMT A & B), and Mobile Tower of Hanoi Test. Thus, participants completed the entire 14-day protocol with ≤84 ecological momentary assessment surveys and 28 MCA tasks. Participants also completed a lab-based neuropsychological test battery during the initial lab visit.

RESULTS

High adherence rates were observed (77% for M-TMT B to 85% for M-SCWT) during repeated administration of MCAs. Learning effects were observed in nearly all tests (P<.024-.001), except for the Mobile Spatial Memory Test Forward. Stability estimates across MCAs ranged from poor to moderate, with higher reliability for M-SCWT and lower stability for M-TMT A and Mobile Tower of Hanoi Test. Agreement between MCAs and corresponding neuropsychological tests varied by domain, with stronger concordance for memory tasks and weaker agreement for inhibition and cognitive flexibility tasks.

CONCLUSIONS

These findings are the first to demonstrate the feasibility and initial psychometric properties of smartphone-based assessments of cognitive function in individuals with stroke in daily life. MCAs may serve as a promising complement to traditional neuropsychological assessments, with further refinement needed to maximize their impact on rehabilitation research and practice.