Current Low-Cost Video-Based Motion Analysis Options for Clinical Rehabilitation: A Systematic Review.

BACKGROUND: Physical therapists, as clinical human movement experts, must qualitatively evaluate patients' functional and biomechanical impairments. There are now low-cost 2- and 3-dimensional video measurement systems that can be used to increase the precision and reliability of these qualitative clinical assessments. PURPOSE: The purpose of this study was to systematically review current low-cost video-based methods for motion analysis compared with gold-standard 3-dimensional biomechanical methods. DATA SOURCES: Electronic searches were conducted until January 2018 within the following databases: MEDLINE via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Scopus, and the Institute of Electrical and Electronics Engineers. STUDY SELECTION: Studies designed to evaluate criterion-referenced validity and/or reliability of video-based motion analysis technologies within the last 20 years were included. English-language articles dealing with human rehabilitation were considered. DATA EXTRACTION: Data extraction was independently completed by 3 reviewers, and methodological quality was assessed using the 2018 Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. Articles were organized for analysis on the basis of type of motion analyzed and category of each low-cost technology used. DATA SYNTHESIS: With 20 articles meeting selection criteria, 10 low-cost motion analysis platforms were presented, each examining different functional movement-dependent variables. Overall article quality was "low" or "very low" on the basis of Consensus-Based Standards for the Selection of Health Measurement Instruments scoring. Correlations between low-cost and 3-dimensional gold standard systems ranged widely from "poor" agreement (r = 0.025) to "strong" agreement (r = 0.992). Spatiotemporal gait parameters consistently outperformed planar joint angle data. Reliability was better measured than concurrent validity. A summary table was developed to assist clinicians in choosing which motions could potentially be measured accurately by each low-cost platform on the basis of current findings. LIMITATIONS: Databases available to researchers were more clinical/medical in nature, and this review was written from that clinically based perspective. Lack of standardized protocols and methodology within included studies was common, making generalizability difficult. CONCLUSIONS: Research attempting to validate newer low-cost movement analysis systems is limited in quality. Measurement of only certain variables should be considered when these tools are used. Further research is warranted, because these devices still have potential clinical utility for supplementing qualitative movement assessment with objective outcome measures.

Managing Eating Disorders on a General Pediatrics Unit: A Centralized Video Monitoring Pilot.

Adolescents with severe eating disorders require hospitalization for medical stabilization. Supervision best practices for these patients are not established. This study sought to evaluate the cost and feasibility of centralized video monitoring (CVM) supervision on a general pediatric unit of an academic quaternary care center. This was a retrospective cohort study of nursing assistant (NA) versus CVM supervision for girls 12-18 years old admitted for medical stabilization of an eating disorder between September 2013 and March 2017. There were 37 consecutive admissions (NA = 23 and CVM = 14). NA median supervision cost was more expensive than CVM ($4,104/admission vs $1,166/admission, P < .001). Length of stay and days to weight gain were not statistically different. There were no occurances of family refusal of CVM, conversion from CVM to NA, technological failure, or unplanned discontinuation. Video monitoring was feasible and associated with lower supervision costs than one-to-one NA supervision. Larger samples in multiple centers are needed to confirm the safety, acceptability, and efficacy of CVM.

Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.

BACKGROUND: The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. OBJECTIVES: Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. METHODS: From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Tromsø University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: < 3.5 hours=a half day's salary, > 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps. RESULTS: Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription practices were not statistically different between the two randomized groups. In addition, telemedicine consultations were shorter than traditional visits (38.8 vs 43.7 min, P<.001). The travel cost per rural individual (292/402, 73%) was €249, and estimated lost income was €234 per visit. The travel cost in the urban area (110/402, 27%) was €6, and estimated lost income was €117 per visit. The median traveling distance for rural patients was 526 km (range 1892 km), and the median traveling time was 7.8 hours (range 27.3 hours). Rural patients had a longer waiting time than urban patients (64 vs 47 days, P=.001), and fewer women were referred from rural areas (P=.04). Rural women reported higher pain scores than urban women (P=.005). CONCLUSION: Our study shows that telemedicine is an accepted, feasible, time-saving, and cost-saving alternative to traditional specialist consultations for nonacute headaches. TRIAL REGISTRATION: Clinicaltrials.gov NCT02270177; http://clinicaltrials.gov/ct2/show/NCT02270177 (Archived by WebCite at http://www.webcitation.org/6hmoHGo9Q).

Low-cost high-speed imaging system for observing vocal fold vibration in voice disorders.

PURPOSE: The aim of this study was to establish a method to observe vocal fold vibration using a low-cost high-speed laryngeal imaging system. PROCEDURES: We assembled a high-speed imaging system with a consumer digital camera and a rigid laryngeal endoscope. The camera can shoot digital images at a rate of 1,200 frames per second and be purchased for about USD 1,000 in Japan. RESULTS: We examined the normal and pathological vocal folds of 215 subjects with our new system and analyzed the vocal fold vibration in these subjects by playback of a video and kymograph images. CONCLUSIONS: Our high-speed laryngeal imaging system is highly cost-effective and can be a useful tool for examining the vocal folds of patients with voice disorders.

Cost efficiency comparison of four video-based techniques for assessing upper arm postures.

Many video-based techniques for assessing postures at work have been developed. Choosing the most appropriate technique should be based on an evaluation of different alternatives in terms of their ability to produce posture information at low input costs, i.e. their cost efficiency. This study compared four video-based techniques for assessing upper arm postures, using cost and error data from an investigation on hairdressers. Labour costs associated with the posture assessments from the video recordings were the dominant factor in the cost efficiency comparison. Thus, a work sampling technique associated with relatively large errors appeared, in general, to be the most cost-efficient because it was labour-saving. Measurement bias and other costs than labour cost for posture assessment influenced the ranking and economic evaluation of techniques, as did the applied measurement strategy, i.e. the numbers of video recordings and repeated assessments of them. PRACTITIONER SUMMARY: The cost efficiency of four video-based techniques for assessing upper arm postures was compared. Work sampling techniques were in general more cost efficient than continuous observations since they were labour-saving. Whilst a labour cost dominated the comparison, 'hidden costs', bias and measurement strategy also influenced this dominance.

Economic evaluation alongside a clinical trial of psycho-educational interventions to improve adjustment to survivorship among patients with breast cancer.

PURPOSE: There is little economic research on psychosocial interventions. We aimed to collect data alongside a randomized trial to compare the costs and benefits of three psycho-educational strategies to improve transition to cancer survivorship. METHODS: We evaluated the incremental delivery costs per unit increase in energy (using the Medical Outcomes Study vitality scale) or decrease in distress (from the Revised Impact of Events Scale) in the 6 months postintervention. We also evaluated 1-year post-treatment health care costs. RESULTS: The costs of the control, video, and video plus counseling arms were $11.30, $25.85, and $134.47 per person, respectively. The video costs were $2.22 per unit increase in energy compared with control; among women who were the least prepared for transition, the video was more effective, resulting in even lower costs. The video cost $7,275 per unit change in distress versus control, but costs were lower in the subgroup least prepared for transition ($355). The counseling arm was more expensive and less effective than the video for virtually all end points. However, in one group, women more prepared for transition, counseling cost $1,066 per unit decrease in distress compared with the video. Health care costs tended to increase as intervention intensity increased. CONCLUSION: There are no standards for evaluating cost-effectiveness of trials with psychosocial end points. In this trial, the educational video was the most cost-effective way to improve transition to survivorship. It will be important to confirm whether there is an increased use of services after such interventions and if this represents appropriate use of rehabilitative and supportive care or over-use.

Is a videotape to change beliefs and behaviors superior to a standard videotape in acute low back pain? A randomized controlled trial.

BACKGROUND CONTEXT: Cognitive behavioral therapy has been used successfully in acute low back pain (LBP) treatment, but the use of a cognitive behavioral videotape as an adjunct to treatment has not been studied. PURPOSE: To determine outcomes for patients with acute LBP receiving a videotape designed to change beliefs and behaviors compared with a standard instructional videotape. STUDY DESIGN/SETTING: Randomized controlled trial; multidisciplinary clinic in an academic setting. PATIENT SAMPLE: Consecutive subjects with less than 3 months of LBP. Of 224 eligible subjects, 138 participated and completed the initial questionnaires. OUTCOME MEASURES: Oswestry Disability Index, Pain and Impairment Relationship Scale, Fear-Avoidance Beliefs Questionnaire; medical costs related to LBP and total medical costs incurred by participants during 1 year of follow-up. METHODS: Subjects were randomly assigned to receive a behavioral videotape or a control videotape. Other than the videotape, usual care was provided to each patient. RESULTS: No significant differences in any outcome measures or medical costs between the two groups at 12 months. However, baseline Vermont Disability Prediction Questionnaire was significantly lower in those who completed the entire study compared with those who did not complete the study. CONCLUSIONS: Compared with a standard instructional videotape, a behavioral videotape did not change beliefs, outcomes, or costs over 1 year. Cost-effective behavioral interventions with high patient retention rates are needed, especially for those at greatest risk of high utilization of resources.

Low-cost three-channel video for assessment of the clinical consultation.

Single-channel video is an established method for assessing the clinical consultation; however, it has limitations. While previous research has concluded that three-channel video recording of clinical consultations offers advantages, using professional equipment made costs prohibitive. In this study we set out to establish whether the benefits of three-channel video could be achieved using low-budget consumer-level equipment. Using a kit assembled for around euro 1000, we produced three-channel video recordings of simulated consultations. We then showed single- and three-channel versions of the videos to a panel of health professionals and recorded their opinions regarding the quality of the material and the level of information presented. We found that our budget three-channel set-up provided the same advantages as professional three-channel video, while the cost and complexity of the process was minimal. It is now affordable as well as feasible to use a budget set-up three-channel video system for training clinicians and assessing the impact of the computer on the consultation.

Telepsychiatry: critical dimensions for forensic services.

The use of telepsychiatry technology and services has gained attention among legal and clinical practitioners. In the current article, telepsychiatry is defined, and an innovative model of telepsychiatry care delivery that is in use in a child and adolescent forensic evaluation clinic is examined. Critical factors specific to forensics services are examined, as are those specific to telepsychiatry, including transmission mode, privacy and confidentiality, expense, quality of care, face-to-face versus video transmission, user satisfaction, and liability concerns in the use of telepsychiatry.

Conversion to digital technology improves efficiency in the pediatric echocardiography laboratory.

BACKGROUND: Although the videotape method (VTM) is commonly used to record and intrepret ecocardiographic images, many pediatric echocardiographers are considering acquiring to, interpreting from, and storing their images to digital disk using the single-beat digital acquisition method (SBM). The paucity of image redundancy using SBM should translate into improved laboratory efficiency compared with VTM, but hard data are lacking. The purpose of this study was to test the hypothesis that the time to acquire images to videotape using VTM and to disk using SBM would be the same for normal hearts and corresponding congenital heart diseases, but interpretation times would be shorter using SBM. METHODS: We measured the times to acquire and interpret 403 echocardiograms using standard VTM from Children's Hospital in Cincinnati, Ohio, and 352 echocardiograms acquired using SBM from Children's Hospital in San Diego, Calif. Diagnostic categories at each site included: (1) normal, (2) simple shunt or isolated valve disease, and (3) multiple-lesion disease. RESULTS: As a group, SBM echocardiograms included more hemodynamic measurements and took more time to acquire (P <.037), but less time to read (P <.001) than corresponding images acquired using VTM. Using SBM, it took more time to acquire normals and isolated valve or shunt lesions, whereas the average time to acquire multiple-lesion disease was the same using both VTM and SBM. With SBM, in contrast, interpretation times were significantly less for all corresponding diagnoses. CONCLUSION: SBM studies took longer to acquire because more hemodynamic measurements were acquired, but they were read in less time than corresponding VTM studies even though all videotapes were replayed in search fast-forward mode. Pediatric echocardiographers can increase their laboratory efficiency by converting from VTM to SBM.

Cost of managing digital diagnostic images for a 614-bed hospital.

The cost of recording and archiving digital diagnostic imaging data is presented for a Radiology Department serving a 614 bed University-Hospital with a large outpatient population. Digital diagnostic imaging modalities include computed tomography, nuclear medicine, ultrasound, and digital radiography. The archiving media include multiformat video film recordings, magnetic tapes, and disc storage. The estimated cost per patient for the archiving of digital diagnostic imaging data is presented.

Use of videotaped interventions in research.

Evaluating conceptual and methodological issues are important considerations when developing a videotape for research intervention. The process of developing a videotape for research involves several critical steps to maintain scientific rigor during the project. Establishing content validity of the videotape script and maintaining scientific integrity while producing the videotape are key components. Issues such as copyright and intellectual property are important considerations. The use of videotape provides a consistent method of providing information to research subjects. Careful attention to the research process during each phase of development of the videotape will enhance the success of the project.

Accuracy and cost- and time-effectiveness of digital clip versus videotape interpretation of echocardiograms in patients with valvular disease.

BACKGROUND: Although digital and videotaped images are known to be comparable for the evaluation of left ventricular function, their relative accuracy for assessment of more complex anatomy is unclear. We sought to compare reading time, storage costs, and concordance of video and digital interpretations across multiple observers and sites. METHODS: One hundred one patients with valvular (90 mitral, 48 aortic, 80 tricuspid) disease were selected prospectively, and studies were stored according to video and standardized digital protocols. The same reviewer interpreted video and digital images independently and at different times with the use of a standard report form to evaluate 40 items (e.g., severity of stenosis or regurgitation, leaflet thickening, and calcification) as normal or mildly, moderately, or severely abnormal. Concordance between modalities was expressed at kappa. Major discordance (difference of >1 level of severity) was ascribed to the modality that gave the lesser severity. CD-ROM was used to store digital data (20:1 lossy compression), and super-VHS videotape was used to store video data. The reading time and storage costs for each modality were compared. RESULTS: Measured parameters were highly concordant (ejection fraction was 52% +/- 13% by both). Major discordance was rare, and lesser values were reported with digital rather than video interpretation in the categories of aortic and mitral valve thickening (1% to 2%) and severity of mitral regurgitation (2%). Digital reading time was 6.8 +/- 2.4 minutes, 38% shorter than with video (11.0 +/- 3.0, range 8 to 22 minutes, P <.001). Compressed digital studies had an average size of 60 +/- 14 megabytes (range 26 to 96 megabytes). Storage cost for video was A$0.62 per patient (18 studies per tape, total cost A$11.20), compared with A$0.31 per patient for digital storage (8 studies per CD-ROM, total cost A$2.50). CONCLUSION: Digital and video interpretation were highly concordant; in the few cases of major discordance, the digital scores were lower, perhaps reflecting undersampling. Use of additional views and longer clips may be indicated to minimize discordance with video in patients with complex problems. Digital interpretation offers a significant reduction in reading times and the cost of archiving.