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.

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.