Remote Assessment of Physical Function and Physical Activity in Adults With Autism Spectrum Disorder: Protocol for Feasibility, Validity, and Reliability Study.

backgroundAdults with autism spectrum disorder (ASD) are at increased risk for chronic health conditions and reduced quality of life (QoL), often linked to lower physical activity (PA), motor impairments, and barriers to health care access. Although communication and social differences in ASD are well documented, motor impairments such as deficits in coordination, balance, and gait remain understudied in adulthood despite their relevance to fall risk and PA participation. Telehealth and wearable technologies may improve access to physical therapy assessment and remote monitoring of physical function in this underserved population.

objectiveThis pilot study aims to evaluate the feasibility, construct validity, and rating reliability of remotely administered physical function and balance assessments in adults with ASD and to examine racial and ethnic disparities and associations among physical function, PA, fall risk, and QoL.

methodsThis pilot study uses a 2-phase, cross-sectional, noninterventional design with remote data collection in legally independent adults aged 18-59 years with ASD who were recruited through the Simons Powering Autism Research and Knowledge (SPARK) registry. Participants complete self-report questionnaires; 2 weeks of wearable step monitoring using a Fitbit Inspire 3 (Google LLC) device; and, for a randomized subset of 25 participants, 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. Construct validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function measures will be examined using hypothesis testing with related indicators of health and functioning, including steps per day, lower-extremity functional outcome surveys, fall risk screening surveys, and comorbidity burden. Interrater and intrarater reliability of remote performance scoring will be evaluated from video-recorded sessions scored by 6 raters using intraclass correlation coefficients. Secondary analyses will examine racial and ethnic disparities in physical function, PA, and QoL, as well as associations among these variables and moderation by race and ethnicity.

resultsStudy funding was available from August 2024 to May 2025. Recruitment occurred from December 2024 to March 2025, and final data collection was completed in May 2025. By May 2025, 155 adults with ASD had been recruited, of whom 65.2% were female and 77% identified as Black or Hispanic. Data analysis is projected to be completed in July 2026, and submission of the primary results manuscript is anticipated in August 2026.

conclusionsThis protocol describes a pilot study designed to evaluate the feasibility, construct validity, and equity relevance of remotely administered physical function assessments in adults with ASD. If supported, the findings may provide preliminary evidence for more accessible telehealth-based assessment approaches and inform larger studies on physical functioning, PA, and QoL in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/86020.