In Patients Admitted to a Home Rehabilitation Service, Can a Physical Examination of Muscle, Fat, and Fluid Status be Completed Remotely Via Videocall? A Validation Study

Abstract

Background: Teleconsultation via videocall by a dietitian may allow remote diagnosis of malnutrition amongst patients undertaking home rehabilitation; however, whether or not a physical examination can be performed accurately remotely has not yet been determined.

Objective: This study aimed to compare agreement between an in-person and videocall by a dietitian for overall physical assessment in patients admitted to a home rehabilitation service.

Design: This was a cross-sectional diagnostic accuracy study.

Participants and setting: This study involved 71 adults admitted to the home rehabilitation program at Flinders Medical Centre in Adelaide, South Australia, Australia, between September 2019 to November 2019 and August 2020 to November 2020.

Main outcome measures: Validity of the videocall by a dietitian to undertake a physical assessment was determined using an in-person physical assessment completed by a trained dietitian in the participant's own home. A dietitian blinded to the in-person assessment completed the physical examination via a videocall to determine the presence and degree of deficit at each anatomical site and make an overall physical assessment.

Statistical analyses performed: Percentage agreement, weighted kappa, sensitivity, and specificity were determined to assess agreement between videocall and in-person assessments undertaken by a dietitian.

Results: The overall videocall physical examination by a dietitian rating achieved a percentage agreement of 69.0% against the in-person assessment by a dietitian, with a weighted kappa agreement of 0.658 (95% CI 0.530 to 0.786), sensitivity of 87.5%, and specificity of 81.1%.

Conclusions: The substantial weighted kappa, good sensitivity, and specificity supports the use of the physical assessment in contributing to diagnosing malnutrition via videocall in home rehabilitation settings. Services that are without a local dietetic workforce should consider using dietitians to undertake videocalls for the physical examination component of nutrition assessment to facilitate timely nutrition assessment and optimal nutrition interventions, as well as support review of nutrition interventions.

Keywords: Nutrition assessment; Patient-generated subjective global assessment; Rehabilitation; Telehealth; Validity.