Remote Assessment of Physical Function and Physical Activity in Adults With Autism Spectrum Disorder: Protocol for Feasibility, Validity, and Reliability Study.
Nunez-Gaunaurd A, Tovin M, et al. • JMIR research protocols • 2026
This protocol describes a pilot study designed to evaluate the feasibility, construct validity, and equity relevance of remotely administered physical function assessments in adults with autism spectrum disorder.
Key Findings
Background
Adults with ASD face increased risk for chronic health conditions and reduced quality of life, often linked to lower physical activity, motor impairments, and barriers to health care access.
Motor impairments in ASD include deficits in coordination, balance, and gait.
These motor impairments remain understudied in adulthood despite their relevance to fall risk and PA participation.
Communication and social differences in ASD are well documented, but motor impairments receive comparatively less research attention in adult populations.
Results
The study recruited 155 adults with ASD by May 2025, with notably high representation of female and minority participants.
Recruitment occurred from December 2024 to March 2025, with final data collection completed in May 2025.
Of 155 recruited adults with ASD, 65.2% were female.
77% of participants identified as Black or Hispanic.
Participants were recruited through the Simons Powering Autism Research and Knowledge (SPARK) registry.
Eligible participants were legally independent adults aged 18-59 years with ASD.
Methods
The study uses a two-phase, cross-sectional, noninterventional design with fully remote data collection methods including self-report questionnaires, wearable step monitoring, and telehealth-based physical function assessment.
All participants complete self-report questionnaires and 2 weeks of wearable step monitoring using a Fitbit Inspire 3 (Google LLC) device.
A randomized subset of 25 participants also complete 1 remote, telehealth-based physical function assessment session.
Remote performance-based measures include the Five Times Sit-to-Stand, 30-second Sit-to-Stand, standing balance under eyes open and eyes closed conditions, and single-leg stance under eyes open and eyes closed conditions.
Study funding was available from August 2024 to May 2025.
Methods
Construct validity of PROMIS physical function measures will be examined using hypothesis testing with multiple related health indicators.
Related indicators include steps per day, lower-extremity functional outcome surveys, fall risk screening surveys, and comorbidity burden.
The Patient-Reported Outcomes Measurement Information System (PROMIS) physical function measures are the primary self-report instrument under examination.
This validity analysis is part of the planned data analysis projected to be completed in July 2026.
Methods
Interrater and intrarater reliability of remote performance scoring will be evaluated using intraclass correlation coefficients from video-recorded sessions scored by multiple raters.
Six raters will score video-recorded remote assessment sessions.
Intraclass correlation coefficients (ICCs) will be used to assess both interrater and intrarater reliability.
Reliability analyses apply to the subset of 25 participants who completed the telehealth-based physical function assessment session.
Methods
Secondary analyses will examine racial and ethnic disparities in physical function, physical activity, and quality of life, as well as associations among these variables and moderation by race and ethnicity.
The high recruitment of Black (and Hispanic) participants (77% combined) positions the study to meaningfully examine equity-related questions.
Moderation by race and ethnicity will be specifically tested in association analyses.
These secondary analyses are designed to address an understudied area of health equity within the ASD adult population.
Results
Data analysis is projected to be completed in July 2026, with submission of the primary results manuscript anticipated in August 2026.
The study timeline spans from funding availability in August 2024 through anticipated manuscript submission in August 2026.
This is a protocol paper; primary results have not yet been reported.
The pilot study is designed to provide preliminary evidence to inform larger studies on physical functioning, PA, and QoL in adults with ASD.
What This Means
This research describes the design and early recruitment results of a pilot study examining whether physical fitness and balance assessments can be conducted remotely—via telehealth and wearable fitness trackers—in adults with autism spectrum disorder (ASD). Many adults with ASD have difficulties with movement, balance, and coordination that increase their risk of falls and limit their physical activity, but they also face significant barriers to accessing in-person healthcare. The study recruited 155 adults with ASD through an online registry, with a notably diverse sample: 65% were female and 77% identified as Black or Hispanic, groups that are often underrepresented in ASD research. Participants wore a Fitbit device for two weeks, completed online surveys, and a smaller subgroup of 25 people participated in a live video-based physical assessment.
This research suggests that telehealth-based tools may offer a more accessible way to evaluate physical health in adults with ASD, particularly for those who face barriers to traditional clinic visits. The study is also specifically designed to look at whether there are racial and ethnic differences in physical function, physical activity, and quality of life among adults with ASD—an area that has received very little scientific attention. Researchers will test whether commonly used patient-reported outcome surveys (PROMIS) accurately capture physical function in this population, and whether remote video scoring of movement tests is consistent across different raters.
Because this is a protocol paper, the actual findings from the assessments have not yet been published—data analysis is expected to be completed in mid-2026. However, if the remote assessment methods prove feasible and valid, the results could support wider use of telehealth for physical therapy evaluation in the ASD community and lay the groundwork for larger studies focused on improving physical health and quality of life for this underserved population.
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Nunez-Gaunaurd A, Tovin M, Hale M, Li T, Bhat A. (2026). Remote Assessment of Physical Function and Physical Activity in Adults With Autism Spectrum Disorder: Protocol for Feasibility, Validity, and Reliability Study.. JMIR research protocols. https://doi.org/10.2196/86020