142nd APHA Annual Meeting and Exposition

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311043
Validation of Telehealth for Home Assessment of Transfer Mobility in Individuals with Spinal Cord Injury

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 3:10 PM - 3:30 PM

Ruth Cronkite, PhD , Center for Innovation to Implementation, Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA
Michelle Hill, RN, MS , Spinal Cord Injury Center, VA Palo Alto Health Care System, Palo Alto, CA
B. Jenny Kiratli, PhD , Spinal Cord Injury Center, VA Palo Alto Health Care System, Palo Alto
Max Halvorson, MA , Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
Doug Ota, MD , Spinal Cord Injury Center, VA Palo Alto Health Care System, Palo Alto, CA
Objective: Telemedicine has potential value for monitoring individuals with SCI/D, especially for prevention and early detection and management of secondary conditions, by allowing remote assessments and corresponding rehabilitation opportunities in a home setting.  We determined the accuracy of telemedicine for assessment of transfer mobility - performing a safe wheelchair to bed transfer – in persons with SCI/D in a home setting. 

Methods: Three assessment modality conditions were compared:  telephone, videoconferencing, and in-person.  Each of Evaluators were randomly assigned to a modality condition for each of 54 participants, who performed transfers in each of the three conditions, in random order.  Accuracy was estimated for the telephone condition and the videoconferencing condition relative to the in-person condition (the gold standard), using Kappa coefficients and percent agreement.  Evaluators also provided input about their clinical confidence in the telehealth assessments. 

Results: There was a consistently higher agreement between the videoconference condition and the in-person condition (Kappa = .70, 85% agreement) than between the telephone condition and the in-person condition (Kappa = .30, 52% agreement).  Evaluators felt more confident in their assessment in the videoconference condition (97% felt confident or very confident) compared to the telephone condition (50% felt confident or very confident).

Conclusions: Videoconference assessments are close to in-person home visit assessments, supporting videoconferencing in monitoring individuals with SCI/D in their home for performance of safe wheelchair to bed transfers.  Such a telehealth modality allows for more frequent assessments and rehabilitation efforts, which may help prevent serious secondary conditions such as pressure ulcers.

Learning Areas:

Communication and informatics
Provision of health care to the public

Learning Objectives:
Compare the accuracy of two telemedicine modalities, telephone and videoconference, on performance of transfer mobility in persons with spinal cord injuries or disorders (SCI/D) relative to in-person assessments in a home setting, and compare evaluators’ confidence in telephone and videoconference assessment of transfer mobility.

Keyword(s): Telehealth, Disabilities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a co-investigator on two federally funded grants focusing in the area of telehealth for persons with spinal cord injuries or disorders and have published two previous articles in this area. One publication focuses on telehealth for assessing pressure ulcers among persons with spinal cord injuries or disorders. The other is a cost modeling analysis of different telehealth scenarios for assessing persons with spinal cord injuries or disorders.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.