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Equivalence of Face-to-face and Videoconference Administration of the ESS and Functional Reach for Post-Stroke Patients

Equivalence of Face-to-face and Videoconference Administration of the ESS and Functional Reach for Post-Stroke Patients. Sue Palsbo, PhD National Rehabilitation Hospital / George Mason University Steven J. Dawson, PT INTEGRIS/Jim Thorpe Lynda Savard, PT Sister Kinney Rehabilitation Institute

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Equivalence of Face-to-face and Videoconference Administration of the ESS and Functional Reach for Post-Stroke Patients

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  1. Equivalence of Face-to-face and Videoconference Administration of the ESS and Functional Reach for Post-Stroke Patients Sue Palsbo, PhD National Rehabilitation Hospital / George Mason University Steven J. Dawson, PT INTEGRIS/Jim Thorpe Lynda Savard, PT Sister Kinney Rehabilitation Institute Marc Goldstein, EdD American Physical Therapy Association

  2. RERC on Telerehabilitation Funding • Robert Wood Johnson Foundation, Methodologies Grant, #49143 • US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR), Rehabilitation Engineering and Research Center (RERC) on Telerehabilitation #H133E990007-00C

  3. Study Partners • Professional Association • American Physical Therapy Association (APTA) • Rehabilitation Hospitals • INTEGRIS/Jim Thorpe (Oklahoma) • Sister Kinney Institute (Minnesota)

  4. Goal • Determine if post-stroke functional assessments tendered by a remote therapist are equivalent to a face-to-face assessment. • Move beyond “proof of concept” study; design and execute an equivalence trial

  5. Criteria for Selecting Measures (1) Be appropriate and relevant to people with stroke. (2) Have known psychometric properties (validity and reliability) published in peer-reviewed literature. (3) Wide use in research and clinical practice. (4) Be visually based (that is, the therapist can measure using televideo without touching the patient). (5) All measures can be completed within 30 minutes.

  6. Design Issues for Measuring Equivalence • Serial correlation bias • Measure simultaneously, not serially • Inter-rater reliability • Use measurement tools with published reliability values • Training • Bias in administration • Switch off the therapist conducting the assessment

  7. Subject Randomization Total: 26 paired observations

  8. Measures • Functional reach • European stroke scale • Level of consciousness • Comprehension • Speech • Visual field • Gaze • Facial movement • Arm – maintain position when outstretched

  9. Measures, con’t. • Arm – raising • Wrist extension • Fingers • Leg – maintain position • Leg – flex • Dorsiflexion of foot • Gait

  10. Equipment and Methods • Large monitor video-conferencing equipment • Transmission speed of 384 kbs • Therapists recorded their scores simultaneously • Therapists were blind to each other’s scoring • Recorded level of confidence in their scores

  11. Recruitment, Inclusion, Exclusion • Convenience sample • $5 honorarium • Patients with a history of stroke • Outpatients • Inpatients • Cognitive ability to comprehend informed consent • No visual field cuts

  12. Measuring Agreement • Kappa • Have to have both raters assign rankings over the same range • Lin’s rho • Only for continuous measures; OK for functional reach, but not interval scales such as ESS • Raw percentage agreement

  13. Results • Functional reach: Lin’s rho – 0.98

  14. Conclusions and Future Research • Televideo assessments are worth pursuing • Need to look at POTS videophones • Need to develop clinical protocols (positioning camera; patient safety; appropriate candidates) • Need to identify more continuous measurement scales and demonstrate equivalence • Maintain movement toward RCTs of teletherapy

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