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

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.