Patient experience survey in telemedicine for spinal cord injury patients.

STUDY DESIGN: Patient feedback study. OBJECTIVES: To measure how patients value the telemedicine consultation service at the National Spinal Injuries Centre over a period of 8 months. SETTING: United Kingdom (south of England). METHODS: Telephone survey conducted by an external surveyor who does not work in the department. RESULTS: Our study showed that most patients (n=29) found the service of high quality and useful to their care. CONCLUSION: This provides evidence, from the spinal cord injury patients' perspective, that telemedicine service has an important role in their management.

Reliability of the international spinal cord injury bowel function basic and extended data sets.

STUDY DESIGN: This study was designed as an international validation study. OBJECTIVE: The objective of this study was to assess the inter-rater reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets. SETTING: Three European spinal cord injury centers. METHODS: In total, 73 subjects with spinal cord injury and a history of bowel dysfunction, out of which 77% were men and median age of the subjects was 49 years (range 20-81), were studied. The inter-rater reliability was estimated by having two raters complete both data sets on the same subject. First and second tests were separated by 14 days. Cohen's kappa was computed as a measure of agreement between raters. RESULTS: Inter-rater reliability assessed by kappa statistics was very good (≥0.81) in 5 items, good (0.61-0.80) in 11 items, moderate (0.41-0.60) in 20 items, fair (0.21-0.40) in 11 and poor (<0.20) in 5 items. CONCLUSION: Most items within the International Spinal Cord Injury Bowel Function Data sets have acceptable inter-rater reliability and are useful tools for data collection in international clinical practice and research. However, minor adjustments are recommended.

A systematic review of technical evaluation in telemedicine systems.

We conducted a systematic review of the literature to critically analyse the evaluation and assessment frameworks that have been applied to telemedicine systems. Subjective methods were predominantly used for technical evaluation (59 %), e.g. Likert scale. Those including objective measurements (41%) were restricted to simple metrics such as network time delays. Only three papers included a rigorous standards based objective approach. Our investigation has been unable to determine a definitive standards-based telemedicine evaluation framework that exists in the literature that may be applied systematically to assess and compare telemedicine systems. We conclude that work needs to be done to address this deficiency. We have therefore developed a framework that has been used to evaluate videoconferencing systems telemedicine applications. Our method seeks to be simple to allow relatively inexperienced users to make measurements, is objective and repeatable, is standards based, is inexpensive and requires little specialist equipment. We use the EIA 1956 broadcast test card to assess resolution, grey scale and for astigmatism. Colour discrimination is assessed with the TE 106 and Ishihara 24 colour scale chart. Network protocol analysis software is used to assess network performance (throughput, delay, jitter, packet loss).

Aetiology of pressure sores in patients with spinal cord injury.

One hundred consecutive patients admitted to the National Spinal Injuries Centre, Stoke Mandeville Hospital, with pressure sores were studied to assess the relative importance of factors known to predispose to the development of scores. Loss of feeling was critical, because patients were unable to appreciate pain when the sore was developing. Risk of developing a sore increased with age, but duration of the paralysis was of equal importance. After discharge from hospital the presence of a caring relative or friend was essential for survival. Many patients developed sores because of poor facilities at home or inappropriate advice from those who looked after them. An even more distressing factor was the number of patients who developed sores in hospital owing to inadequate nursing care. There are relatively few paralysed patients in the community, but the lessons learnt in this study may be applied to all patients with orthopaedic injuries and to geriatric patients with limited mobility. Nursing and medical staff must turn patients regularly and ensure that there is proper equipment to relieve pressure on the skin. Patients should not be allowed to sit in a chair if they develop a sacral or trochanteric sore. More effort should be directed towards the appropriate education of patients, their relatives, and all those who are concerned with their welfare.