Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services

Shelley E Keating; Amandine Barnett; Ilaria Croci; Amy Hannigan; Louise Elvin-Walsh; Jeff S Coombes; Katrina L Campbell; Graeme A Macdonald; Ingrid J Hickman

doi:10.1016/j.arrct.2020.100066

Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services

Arch Rehabil Res Clin Transl. 2020 Jun 7;2(3):100066. doi: 10.1016/j.arrct.2020.100066. eCollection 2020 Sep.

Authors

Shelley E Keating¹, Amandine Barnett^{2

3}, Ilaria Croci^{1

4}, Amy Hannigan³, Louise Elvin-Walsh³, Jeff S Coombes¹, Katrina L Campbell^{2

3}, Graeme A Macdonald^{5

6

7}, Ingrid J Hickman^{3

8}

Affiliations

¹ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
² Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
³ Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁴ K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁶ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁷ School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁸ Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.

Abstract

Objective: To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth.

Design: Reliability study: repeated-measure, within-subject design.

Setting: Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week.

Participants: Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments.

Interventions: Not applicable.

Main outcome measures: The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori).

Results: The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [-2.2 to 3.6kg]; waist 0.4 (-1.2 to 2.0) cm [-5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [-19.4 to 34.9mmHg]; DBP 2.4 (-1.4 to 6.2 ) mmHg [-12.2 to 17.0mmHg]; 6MWT, 7.5 (-29.1 to 44.1) m [-127.3 to 142.4m]; STST 0.5 (-0.8 to 1.7) seconds [-4.3 to 5.3s]; maximal push-ups -2.2 (-4.4 to -0.1) [-10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement.

Conclusions: Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.

Keywords: 6MWT, 6-minute walk test; Chronic disease; DBP, diastolic blood pressure; ICC, intraclass correlation coefficient; LTR, liver transplant recipient; LoA, limit of agreement; MCID, minimal clinically important difference; Rehabilitation; SBP, systolic blood pressure; STST, sit-to-stand test; Self-assessment; Technology; Telemedicine.