Telehealth Care: How reliable are our physical therapy outcome measures?

Abstract

Background: Changes in global health have prompted a transition from the in-person healthcare model towards the telehealth care model for patients with a variety of health conditions, including patients with cerebellar impairments and patients with Parkinson’s disease (PD). While it is known that patient satisfaction is high in the telehealth care setting, it is unknown whether the tools that clinicians utilize in the in-person setting are reliable and valid in the virtual setting. Thus, the goal of this project is to evaluate the psychometric properties of two physical therapy (PT) outcome measures, that have been previously established in the clinical in-person setting, in the telehealth setting.

Methods: Nineteen individuals with cerebellar impairments and nineteen individuals with PD were recruited on a voluntary basis. The Scale for Assessment and Rating of Ataxia (SARA) was used to assess the degree of cerebellar damage and the Berg Balance Scale (BBS) was used to assess the impact of PD. Participants completed two testing sessions (one virtual and one in-person) during which the outcome measure of choice was performed. Outcome measure performance was video recorded in both environments. Videos were independently scored by four raters with varying levels of PT experience. Concurrent validity was assessed via Spearman’s Rank Order Correlation Coefficient, α<0.05, comparing the virtual SARA and BBS scores to their “gold standard” in-person scores. Inter-rater reliability for four raters was evaluated with an Intraclass Correlation Coefficient (ICC) (2,4), α<0.05.

Results: The SARA and the BBS were found to have large concurrent validity with Spearman’s rho significant at the two tailed, alpha <0.01, 0.90, n=14; 0.87, n=18, respectively. Similarly, the SARA and the BBS had excellent inter-rater reliability in the clinic ICC (2,4) 0.97 and 0.90, n=19 for both measures. Virtually, the BSS had moderate inter-rater reliability (ICC (2,4) 0.72, n=18) and the SARA had excellent inter-rater reliability (ICC (2,4) 0.98, n=14).

Conclusion: Our study shows that both the SARA and the BBS can be used in the virtual telehealth setting. Additionally, clinicians with varying years of PT experience can accurately score the SARA and the BBS for patients with cerebellar impairments and PD, respectively.