Exploring the Influence of Telepresence on Balance Performance Assessment

With the rapid expansion of telehealth, understanding how video-based assessments influence clinical reasoning is critical for effective rehabilitation. While prior work has examined feasibility and clinician confidence, less is known about how assessment modality shapes observational features underlying decision-making. In this study, physical therapists (PTs) evaluated standing balance either in-person or via video and verbalized their reasoning using a retrospective think-aloud protocol. Transcripts ( n  = 1,760) were thematically analyzed. Overall performance ratings were similar across assessment modalities, but observational content differed. Video assessments were associated with greater attention to temporal aspects of sway, including frequency and timing. In contrast, in-person assessments were associated with greater attention to lower-limb compensatory strategies, including ankle, knee, and hip mechanisms. These findings suggest assessment modality may redistribute attention across observable features rather than altering overall judgment, highlighting the opportunity for training and tools to account for modality-specific differences in clinical observation.