Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 28, 2018
Open Peer Review Period: May 29, 2018 - Jun 18, 2018
Date Accepted: Nov 20, 2018
(closed for review but you can still tweet)
Face-To-Face Versus Video Assessment Of Facial Paralysis: Implications For Telemedicine
ABSTRACT
Background:
Patients with facial nerve paralysis (FNP) experience challenges to accessing healthcare that could potentially be overcome by telemedicine. The reliability of telemedicine, however, has yet to be established in this field.
Objective:
This study aimed to investigate the consistency between face-to-face and video assessment of patients with FNP by experienced clinicians.
Methods:
A repeated-measures design was used. Seven clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardised grading systems (the House-Brackmann, Sydney, and Sunnybrook Facial Grading Systems). Three months later, the same grading systems were used to assess facial palsy in video recordings of the same patients.
Results:
The House-Brackmann system in video assessment had excellent reliability and agreement (ICC=0.780; PCA=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0% to 95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), while that of other branches had good to excellent reliability, and excellent agreement (ICC=0.625 to 0.862; PCA=85.7% to 100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3% to 100.0%), and synkinesis (ICC=-0.037 to 0.637; PCA=69.6% to 87.0%), but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5% to 91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within +/-1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system.
Conclusions:
Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement. However, video assessment does not account for the impact of real-time interactions which occur during tele-assessment sessions.
Citation
Per the author's request the PDF is not available.
Copyright
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