Telerehabilitation for veterans with a lower-limb amputation or ulcer: Technical acceptability of data

Abstract

A study was undertaken to determine the technical acceptability of information available via a customized telerehabilitation system regarding patients with lower-limb ulcers or recent lower-limb amputations receiving care at a Veterans Affairs Medical Center. Among the 54 participants, 57 wounds (39 ulcers, 19 amputation incisions) were evaluated by means of still photographs and skin temperature data sent via ordinary telephone lines. Three experienced clinicians served as raters. Intrarater agreements and McNemar χ 2 tests were assessed between decisions made after telerehabilitation sessions and decisions made by the same rater after in-person sessions. Interrater agreements and κ coefficients were assessed between two raters for both telerehabilitation and in-person sessions. The intrarater agreement on 57 wounds for the primary rater was 93%, and the McNemar test indicated no significant difference in the ratings (p < 0.63). Interrater agreement on 18 wounds was 78% (κ = 0.55, p < 0.02) for the telerehabilitation sessions and 89% (κ = 0.77, p < 0.001) for the in-person sessions. Most qualitative comments by three clinicians on picture quality (54/63 = 86%) and temperature data (39/44 = 88%) were favorable (good to excellent). The information yielded from this study provides evidence that the telerehabilitation system has the potential to present sufficient information to experienced clinicians so they can make informed decisions regarding wound management. The next phase of the study will include in-home trials and improvements in the technology.

Effectiveness of Telemedicine for Distant Wound Care Advice towards Patient Outcomes: Systematic Review and Meta-Analysis

“…Clemensen, et al [23] Outcome: Feasibility & cost 53 Rintala, et al [60] Outcome: Acceptability 54 Rees, et al [61] Outcome: Use of service (acceptability) and finacial outcome 55 Lewis, et al [62] Outcome: Tele service utilization, providers' satisfaction 56 Wirthlin [63] Outcome: Feasibility 57…”

“…Johnson-Mekota, et al [64] Outcome: Patients' and providers' satisfaction 58 Chan, et al [65] Outcome: Using scoring scale 59 Hill, et al 2009 [66] Outcome: Comparing accuracy of assessment 60 Salmhofer, et al [67] Outcome: Comparing accuracy of assessment • Page 4 of 9 •…”

Development of telerehabilitation application with designated consultation categories

“…An early study by Dick et al reported that 76 percent of the patients who participated in the telemedicine assessment were satisfied with the system [11]. Regarding the technical acceptability of information obtained via TR, an overall agreement of 92 percent was reached between the video-based assessment and the face-to-face assessment in a study conducted by Rintala et al [12]. Sanford and Hoenig compared an individualized, comprehensive multifactorial intervention aimed at improving a patient's mobility provided either by a therapist in person in the patient's home or through use of TR and found that the two methods found a similar number of problems, recommended a similar number of interventions, and adopted the interventions at a similar rate with either mode of service delivery [13].…”

Telerehabilitation

“…Although the traditional telephone system continues to be a low-cost alternative for effectively conducting interview assessments by various health care professionals (Cooper et al, 2002;Shaw, Dreyer, & Wittman, 2001;Winters, 2002), the proliferation of advanced communication technologies has broadened the possibilities of conducting evaluations using new and more sophisticated technology. Studies have described the use of telerehabilitation in areas that are of concern to occupational therapy such as evaluation and consultative services for wheelchair prescription (Barlow, Liu, & Sekulic, 2009;Schein, Schmeler, Brienza, Saptono, & Parmanto, 2008;Schein, Schmeler, Holm, Saptono, & Brienza, in press), neurological assessment (Savard, Borstad, Tkachuck, Lauderdale, & Conroy, 2003), lower-limb amputation care or ulcer management (Rintala et al, 2004), and early childhood intervention (Cason, 2009;Heimerl & Rasch, 2009 Clinical reasoning guides the selection and application of appropriate telerehabilitation technology necessary to evaluate client needs and environmental factors. As part of their clinical reasoning, occupational therapists should consider the appropriateness of the use of telerehabilitation to ensure the safe and effective delivery of occupational therapy services that are appropriate for the client's needs and context.…”