Teleassessment of Gait and Gait Aids: Validity and Interrater Reliability.

BACKGROUND: Gait and mobility aid assessments are important components of rehabilitation. Given the increasing use of telehealth to meet rehabilitation needs, it is important to examine the feasibility of such assessments within the constraints of telerehabilitation. OBJECTIVE: The objective of this study was to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment gait scale (POMA-G) and cane height assessment under various video and transmission settings to demonstrate the feasibility of teleassessment. DESIGN: This repeated-measures study compared the test performances of in-person, slow motion (SM) review, and normal-speed (NS) video ratings at various fixed frame rates (8, 15, and 30 frames per second) and bandwidth (128, 384, and 768 kB/s) configurations. METHODS: Overall bias, validity, and interrater reliability were assessed for in-person, SM video, and NS video ratings, with SM video rating as the gold standard, as well as for different frame rate and bandwidth configurations within NS videos. RESULTS: There was moderate to good interrater reliability for the POMA-G (intraclass correlation coefficient [ICC] = 0.66-0.77 across all configurations) and moderate validity for in-person (ß = 0.62; 95% confidence interval [CI] = 0.37-0.87) and NS video (ß = 0.74; 95% CI = 0.67-0.80) ratings compared with the SM video rating. For cane height, interrater reliability was good (ICC = 0.66-0.77), although it was significantly lower at the lowest frame rate (8 frames per second) (ICC = 0.66; 95% CI = 0.54-0.76) and bandwidth (128 kB/s) (ICC = 0.69; 95% CI = 0.57-0.78) configurations. Validity for cane height was good for both in-person (ß = 0.80; 95% CI = 0.62-0.98) and NS video (ß = 0.86; 95% CI = 0.81-0.90) ratings compared with SM video rating. LIMITATIONS: Some lower frame rate and bandwidth configurations may limit the reliability of remote cane height assessments. CONCLUSIONS: Teleassessment for POMA-G and cane height using typically available internet and video quality is feasible, valid, and reliable.

Testing fine motor coordination via telehealth: Effects of video characteristics on reliability and validity.

Background There is limited research about the effects of video quality on the accuracy of assessments of physical function. Methods A repeated measures study design was used to assess reliability and validity of the finger-nose test (FNT) and the finger-tapping test (FTT) carried out with 50 veterans who had impairment in gross and/or fine motor coordination. Videos were scored by expert raters under eight differing conditions, including in-person, high definition video with slow motion review and standard speed videos with varying bit rates and frame rates. Results FTT inter-rater reliability was excellent with slow motion video (ICC 0.98-0.99) and good (ICC 0.59) under the normal speed conditions. Inter-rater reliability for FNT 'attempts' was excellent (ICC 0.97-0.99) for all viewing conditions; for FNT 'misses' it was good to excellent (ICC 0.89) with slow motion review but substantially worse (ICC 0.44) on the normal speed videos. FTT criterion validity (i.e. compared to slow motion review) was excellent (ß = 0.94) for the in-person rater and good ( ß = 0.77) on normal speed videos. Criterion validity for FNT 'attempts' was excellent under all conditions ( r ≥ 0.97) and for FNT 'misses' it was good to excellent under all conditions ( ß = 0.61-0.81). Conclusions In general, the inter-rater reliability and validity of the FNT and FTT assessed via video technology is similar to standard clinical practices, but is enhanced with slow motion review and/or higher bit rate.

Tele-Assessment of the Berg Balance Scale: Effects of Transmission Characteristics.

OBJECTIVE: To compare Berg Balance Scale (BBS) rating using videos with differing transmission characteristics with direct in-person rating. DESIGN: Repeated-measures study for the assessment of the BBS in 8 configurations: in person, high-definition video with slow motion review, standard-definition videos with varying bandwidths and frame rates (768 kilobytes per second [kbps] videos at 8, 15, and 30 frames per second [fps], 30 fps videos at 128, 384, and 768 kbps). SETTING: Medical center. PARTICIPANTS: Patients with limitations (N=45) in ≥1 of 3 specific aspects of motor function: fine motor coordination, gross motor coordination, and gait and balance. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Ability to rate the BBS in person and using videos with differing bandwidths and frame rates in frontal and lateral views. RESULTS: Compared with in-person rating (7%), 18% (P=.29) of high-definition videos and 37% (P=.03) of standard-definition videos could not be rated. Interrater reliability for the high-definition videos was .96 (95% confidence interval, .94-.97). Rating failure proportions increased from 20% in videos with the highest bandwidth to 60% (P<.001) in videos with the lowest bandwidth, with no significant differences in proportions across frame rate categories. Both frontal and lateral views were critical for successful rating using videos, with 60% to 70% (P<.001) of videos unable to be rated on a single view. CONCLUSIONS: Although there is some loss of information when using videos to rate the BBS compared to in-person ratings, it is feasible to reliably rate the BBS remotely in standard clinical spaces. However, optimal video rating requires frontal and lateral views for each assessment, high-definition video with high bandwidth, and the ability to carry out slow motion review.

Benefits and Challenges of Delivering Tele-rehabilitation Services to Rural Veterans.

Veterans residing in underserved rural areas face many barriers to accessing high-quality rehabilitation services. This article describes the benefits and challenges of using technology for delivery of rehabilitation services to rural Veterans using TeleHOME, an innovative tele-rehabilitation program. TeleHOME enables rehabilitation providers to remotely assess the Veteran's functional abilities and needs in his or her own home where these tasks must be performed. This technology increases the ability of all team members to contribute to interdisciplinary care, but also requires greater levels of team integration. One month after the completion of the TeleHOME project, we met with clinicians to discuss their perceptions of whether and how use of the technology affected interdisciplinary care processes, and what approaches were used to meet team-based goals. TeleHOME can improve access to rehabilitation services for rural Veterans, but will also bring about novel integrative care processes that may improve the effectiveness of such services. Recommendations to overcome challenges to optimize the implementation and delivery of TeleHOME services as well as to better inform clinicians working with rural Veterans are discussed.