Telepsychiatry describes the delivery of mental health care through electronic communications. The increase in availability of these services solicits the question, can prescribers accurately conduct the Abnormal Involuntary Movement Scale (AIMS) assessment through video-conferencing? A 2011 trial conducted at the Veterans Administration (VA) Medical Center in Buffalo, New York says yes.
High-quality research has repeatedly demonstrated that remote psychiatric assessments, whether through telephone or two-way video, are as equally effective as in-person interviews. A meta-analysis published in 2005, for example, found no difference in accuracy or satisfaction between telepsychiatric evaluations and those delivered face-to-face (Hyler, Gangure, & Batchelder). Since then, controlled trails continue to demonstrate the equivalence of depression outcomes, psychiatric consultations, and structured interviews delivered via telepsychiatry compared with in-person treatment (O’Reilley et al., 2007; Ruskin et al., 1998; Ruskin et al., 2004; & Shore et al., 2007).
But what about psychiatric evaluations that rely primarily on visual observation rather than auditory input? Specifically, can clinicians reliably use the AIMS to assess for movement disorders associated with antipsychotic medications? This exam consists of 10 clinician-rated questions that assess the severity of abnormal muscle movements in the face, mouth, extremities and trunk on a 5-point scale ranging from 0 (none) to 4 (severe) (IsHak, Burt, & Sederer, 2002). Generally, psychiatric providers conduct an AIMS assessment prior to prescribing antipsychotic medication and at least once every six months thereafter. The AIMS exam is also usually conducted at regular intervals following the discontinuation of antipsychotic medication.
In their 2011 study titled, “The reliability of telepsychiatry for a neuropsychiatric assessment,” Amarendran et al. sought to determine if the AIMS exam could be performed reliably through video conferencing. These researchers recruited 50 adult participants (47 male and 3 female) from the VA Medical Center in Buffalo, New York, who had been taking antipsychotic medication for at least the previous ten years. A majority of participants held a diagnosis of schizophrenia (72%), followed by schizoaffective disorder (20%), and mood disorder (8%).
Each of the 50 participants underwent AIMS assessments by four raters simultaneously. This study utilized the AIMS procedure defined by Muntez and Beniamin (1988). Two of the raters conducted the assessment face-to-face, and the other two raters observed remotely via video conferencing. One of the remote raters directed the interview while all four completed the AIMS assessment form. Each rater rotated his or her location between each participant. The video conferencing equipment used 384 kilo-bits-per-second bandwidth connected on an Internet Protocol Network. The television screen was 27 inches, and raters were able to use the camera to zoom-in on any particular body part.
Using the Intraclass Correlation Coefficient, Amarendran et al. (2011) found no statistical differences in inter-rater reliability of face-to-face verses remote AIMS assessments. The mean global score for face-to-face raters was 1.35, and the mean global score for remote raters was 1.37. Overall, the scores were the same regardless of rater location. In other words, whether in-person or using telepsychiatric technology, clinicians could reliability conduct abnormal motor movement exams.
Before concluding their study, Amarendran et al. (2011) commented on the need for adequate technology to conduct the AIMS exams. Previous research has revealed that higher bandwidth technology resulted in a more reliable assessment of individuals with schizophrenia (Zarate et al., 1997). This same study also found that lower bandwidth correlated and lower patient satisfaction.
The results of this study demonstrate the benefits of video verses telephone psychiatric assessments, as well as the importance of high-quality, fast transmission technology. Future research should attempt to replicate and thus strengthen these findings to facilitate the wider implementation of telepsychiatric services.
