NeuroRehabilitation 49 (2021) 169–177 DOI:10.3233/NRE-218019 IOS Press 169 Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study Robert J. Kanser a , Justin J.F. O’Rourke b and Marc A. Silva a,c,d,e,∗ a Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans’ Hospital, Tampa, FL, USA b Polytrauma Section, Audie L. Murphy Memorial Veterans’ Hospital, San Antonio, TX, USA c Department of Internal Medicine, University of South Florida, Tampa, FL, USA d Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA e Department of Psychology, University of South Florida, Tampa, FL, USA Abstract. BACKGROUND: The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE: The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephone. METHOD: Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS: Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs main- tained adequate specificity (i.e., >90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS < 7 or 21-item test forced choice total correct < 11 led to < 10% false positive classification errors. CONCLUSIONS: Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to- severe TBI. Future investigations including clinical or experimental “feigners” in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended. Keywords: Brain injuries, traumatic, neuropsychological tests, performance validity, telemedicine, TBI ∗ Address for correspondence: Marc A. Silva, Ph.D.; James A. Haley Veterans’ Hospital, Mental Health and Behavioral Sci- ences, 13000 Bruce B. Downs. Blvd. (116-B), Tampa, FL 33612, USA. Tel.:+1 813 972 2000; Fax: +1 813 631 3057; E-mail: marc.silva1@va.gov. 1. Introduction Within neurorehabilitation, neuropsychological evaluations play a critical role in the diagnosis, monitoring, and treatment of cognitive and neurobe- havioral dysfunction following neurological injury or disease. The utility of neuropsychological eval- uations rests on the assumption that examinees are ISSN 1053-8135/$35.00 © 2021 – IOS Press. All rights reserved.