Procedures
The experimental design was an open-label, counterbalanced, crossover, randomised controlled trial. We randomised participants into two groups by order of assessment administration (1:1 ratio): VTC-first and FTF-first. We used stratified block randomisation with age (< 65 years or ≧65 years) and gender as factors, and the block size was randomly varied between 2 and 4. However, there were no entries under the age of 65 years. An assistant not involved in the evaluation generated the random allocation sequence using web software [A nationally certified speech-language pathologist with at least 10 years of clinical experience conducted both, the VTC and FTF assessments, on the same day, with an interval of approximately 60 min. The FTF assessment took approximately 50 min, and the VTC assessment took approximately 60 min. The examiner conducted the VTC assessment remotely by controlling the participant’s PC from a separate room in the same building (central campus at Hokkaido University). No assistant was present during the assessment. We used Webex Meetings (Cisco Systems, Inc.) as a VTC system. We confirmed that the Internet speed was maintained at more than 70 Megabits per second (bps) for both downloads and uploads on all connected devices. We adapted the default value of Webex Meetings, 360 × 180, for image resolution because the goal of this study was a simple and low-cost implementation.