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 utilizing frequent, brief, repeated, in vivo self-administered mobile assessments of cognitive functions. SETTING: Everyday life settings. PARTICIPANTS: 20 participants with mild-to-moderate stroke (mean age: 55.5 years; 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 six ecological momentary assessment (EMA) surveys on self-reported health status, along with four mobile cognitive assessments (MCAs), each administered twice daily. MCAs included the Mobile Stroop Color Word Test (M-SCWT), Mobile Spatial Memory Test (M-SMT) Forward and Backward, Mobile Trail Making Test Parts A and B (M-TMT A & B), and Mobile Tower of Hanoi Test (M-THT). Thus, participants completed the entire 14-day protocol with up to 84 EMA 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 <0.024 to 0.001), except for the M-SMT Forward. Stability estimates across MCAs ranged from poor to moderate, with higher reliability for M-SCWT and lower stability for M-TMT A and M-THT. 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. GOV REGISTRATION NUMBER: Not applicable; this study is not defined as a clinical trial.