Validity of spirometry performed online

Abstract

Spirometry is essential for the diagnosis and management of common respiratory diseases. However, its use and quality are low in primary care. An important reason for this is the technical difficulty in performing conventional spirometry. If high-quality spirometry could be performed online, from the pulmonary function laboratory in hospitals, most of the technical problems could be solved. The aim of the present study was to compare spirometries performed online by remote technicians with conventional spirometry.This was a controlled, randomised crossover study of 261 patients referred from primary care centres for pulmonary consultation. They were randomised to undergo either conventional or online spirometry. The technician, located remotely, controlled the spirometer computer. Using a teleconference link, the technician guided the patient through the spirometry. The comparison between conventional and online spirometries was performed on intention to treat and per protocol bases for spirometric values and quality criteria. Agreement between the two spirometric methods was assessed with a Bland-Altman plot. A subpopulation of off-range patients was also characterised. Finally, intra-and interobserver agreement was evaluated using the intraclass correlation coefficient.No clinically significant differences were seen between the online and conventional spirometric values in both the intention to treat and per protocol analyses. The agreement in Bland-Altman analysis was poorer for intention to treat than for the per protocol analysis. The latter had a lower percentage of off-range patients and high agreement to determine abnormal spirometry in the offrange group. Conventional spirometry had a higher percentage of patients with spirometric quality criteria although the quality criteria difference was only 5.9%, when both procedures were the first to start. Very good agreement was found between intra-and interobserver reliability.Spirometry performed online from a hospital can be an adequate alternative to conventional spirometry for primary care centres.

Telemedicine enhances quality of forced spirometry in primary care

“…We acknowledge that previous reports [11][12][13][14] have indicated the potential of telemedicine to enhance quality of both testing and diagnosis of FS carried out by nonexpert healthcare professionals, but none of the studies show potential for generalisation across the healthcare system due to technological and/or logistical factors precluding their scalability.…”

“…The American Thoracic Society (ATS)/European Respiratory Society (ERS) documents establish well-defined quality control criteria for both equipment and tests, but they do not include indications on strategies to ensure sustained quality assurance in clinical settings wherein nonexpert professionals are likely to perform the tests. Previous experiences in remote support of FS [11][12][13][14] seem to indicate both feasibility and positive outcomes, but none of them shows scalability or potential for generalisation.…”

Misclassification of OSA Severity With Automated Scoring of Home Sleep Recordings

“…OSA severity can also aff ect automated scoring accuracy, which improves with increasing disease severity. 10 Not surprisingly, visual (manual) scoring of portable monitoring data is superior to automated scoring and improves the reliability of automated scoring for both type 3 [11][12][13][14][15][16] and type 4 [17][18][19][20][21][22][23] portable monitors when AHI is used to identify and classify OSA. Similar to the current fi ndings, previously examined automated algorithms tend to underestimate the AHI compared with manual scoring.…”

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

“…Other substantive evidence Sp3,Sp7,Sp11,Sp20,Sp23,Sp24,Sp25,Sp28,Sp41,Sp67,Sp69,Sp70,Sp74,Sp80,Sp81,Sp90,Sp91,Sp99,Sp102,Sp105 Sp4,Sp12,Sp26,Sp30,Sp43,Sp44,Sp53,Sp76,Sp77,Sp96 Sp10,Sp17,Sp20,Sp29,Sp32,Sp51,Sp72,Sp73,Sp78,Sp82,Sp86,Sp93,Sp98 Sp83,Sp104 Sp40 ○, moderate degree of implementation difficulty; ⨁ , low degree of implementation difficulty.…”