'Assessing Adverse Effects of Antipsychotic medications: Comparison between Virtual Physical Examination and In-person Physical Examination'

Background – There are no studies conducted till now for assessing reliability of physical examination done virtually in the context of telepsychiatry, with only 2 studies examining the reliability of visual observations in telepsychiatry and showing contrasting results. Hence need to validate physical examination done virtually. Aims - To compare the reliability of tele-psychiatric assessments in picking up and assessing the severity of Extra Pyramidal Side Effects(EPSE) of antipsychotic medications in comparison with that of In-person physical examination (gold standard). Methods - An observational cross-sectional study where a total of 121 patients with primary psychiatric disorders on antipsychotic medications were recruited from clinical services of NIMHANS in a convenient fashion. A sequential procedure was carried out where an in-person physical examination looking for EPSE along with application of relevant scales was done by an independent examiner. This was immediately followed by a Virtual Physical Examination(ViPE) carried out by another blinded researcher using a 17 question scale created specifically for the ViPE. The scales used to assess severity of antipsychotic side effects were Abnormal Involuntary Movements Scale(AIMS) and Barnes Akathisia Rating Scale(BARS). Results – A total of 54 patients were found to have EPSE in in-person physical examination as opposed to 52 patients in VIPE. The measure of agreement in picking up EPSE between in-person physical examination and VipE was statistically significant (kappa coefficient – 0.832 ,significance<0.001).The agreement in severity of EPSE as compared on the Global outcome of severity AIMS scale 8(kappa coefficient – 0.777 ,significance<0.001) and Global assessment of severity of akathisia in BARS (kappa coefficient – 0.920 ,significance<0.001) were also statistically significant. Conclusion – ViPE is a reliable method to pick up and assess the severity of EPSEs.