JMIR Publications

ABSTRACT

Background:

Rehabilitation provided via telehealth offers an alternative to in-person health care consultations. Effective rehabilitation depends on accurate and relevant assessments that reliably measure changes in function over time. The reliability of a suite of relevant assessments to measure the impact of rehabilitation on physical function during a telehealth consultation is unknown.

Objective:

We aimed to measure the intra-rater reliability of mobility-focused physical outcome measures delivered via telehealth using Zoom (a commonly used telecommunication platform), and inter-rater reliability comparing telehealth with in-person assessments.

Methods:

Healthy volunteers were recruited to complete seven mobility-focussed outcome measures in view of a laptop computer under instruction from a remotely-based researcher. Another in-person researcher (providing the benchmark scores) concurrently recorded their scores. The same researchers collected all of the data. Inter- and intra-rater reliability was assessed for Grip Strength, Functional reach test, Five-time Sit to Stand, 3 and 4 meter walks and Timed up-and-go, using intra-class correlation coefficients (ICC) and Bland-Altman plots. These tests were chosen as they cover a wide array of physical mobility, strength and balance constructs that relate to functional daily activities, require little to no assistance from a clinician, can be performed in the limits of a home environment and were likely to be feasible over a telehealth delivery mode.

Results:

Thirty participants (age 36.2±12.5 years, 63% male) completed all assessments. Inter-rater reliability was excellent for Grip Strength (ICC: 0.99) and Functional reach (ICC: 0.99), good for Five-time Sit to Stand (ICC: 0.842) and 4 Meter Walk (ICC: 0.76), moderate for timed up and go (ICC: 0.64), and poor for 3 Meter Walk (ICC: -0.46). Intra-rater reliability for the remote researcher was excellent for Grip Strength (ICC: 0.91), good for Timed up-and-go, 3 Meter Walk, 4 Meter Walk, Functional reach (ICC: 0.84-0.89) and moderate for Five-time Sit to Stand (ICC: 0.67). Although recorded simultaneously, the timing-based assessments were recorded as significantly longer via telehealth for Five-time Sit to Stand (1.2s), Timed up-and-go (1.0s) and 3 Meter Walk (1.3s).

Conclusions:

High intra-rater reliability of mobility-focused physical outcome assessments measured over telehealth (Zoom) have been demonstrated. Untimed mobility-focussed physical outcome measures have excellent inter-rater reliability between in-person and telehealth measurement. Timed outcome measures recorded approximately one second longer via telehealth, reducing the reliability of shorter duration tests. Small time differences favouring in-person attendance are of a similar magnitude to clinically importance differences, indicating assessments undertaken using telehealth (Zoom) cannot be compared directly with face-to-face delivery. This has implications for clinicians using blended (some face-to-face and some telehealth) assessments.