Are tele-neuropsychology and in-person assessment scores meaningfully different? A systematic review and meta-analysis

Objectives: Despite growing evidence supporting tele-neuropsychology (teleNP), clinicians have voiced concerns about comparability to traditional in-person testing and the limited availability of teleNP practice guidelines. In response, we completed a PRISMA-compliant systematic review and meta-analysis to investigate mean score differences in the context of test-level administration modifications. Methods: Eligible studies included adult participants, within-subject designs, commonly used English-language neuropsychological tests, and mean test scores for teleNP and in-person assessment. Studies were identified in databases (ProQuest, PubMed, EBSCOhost), reference lists, forward citation searches of eligible reports, and published teleNP reviews through July 2024. A multilevel random effects meta-analysis was conducted. Results: Twenty-four studies including 1,197 clinically and geographically diverse participants aged 18-96 and 46 neuropsychological tests representing 11 cognitive domains were synthesized. Results revealed a statistically nonsignificant mean of true effect sizes, Cohen's dz = .01, 95% CI [-0.01, .04], 95% PI [-0.04, .07], z = .89, p = .37. Qualitative exploration of administration modifications revealed extensive variability and inconsistent reporting. Discussion: Limitations include publication bias favoring null findings. Risk of bias was judged to be low for most studies. Findings suggest teleNP has a nonsignificant and exceptionally minimal effect on test scores with a high certainty of evidence. Mean in-person test scores were 0.01 standard deviations greater than teleNP. Examination of mean differences revealed 77% of tests/subtests with a difference of less than one point. This updated review supports continued application of teleNP and encourages additional research on administration modifications to standardize practice. PROSPERO 2024: CRD42024530068.