Veteran and Provider Satisfaction with a Home-Based Telerehabilitation Assessment for Wheelchair Seating and Mobility

Reliability of home-based remote and self-assessment of transfers using the Transfer Assessment Instrument among wheelchair users with spinal cord injury

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To evaluate the reliability of home-based remote and self-assessment of transfer quality using the Transfer Assessment Instrument (TAI) among wheelchair users with spinal cord injury (SCI).

SETTING

Participant's home environment.

METHODS

Eighteen wheelchair users with SCI transferred from their wheelchair to a surface of their choice (bed, sofa, or bench) in their homes. During a live video conference, the transfer was recorded and evaluated live using the TAI (rater 1). Participants completed a self-assessment of their transfer using the TAI- questionnaire (TAI-Q). Two additional raters (raters 2 & 3) completed asynchronous assessments by watching recorded videos. Interrater reliability was assessed using Intraclass Coefficient Correlations (ICC) to compare rater 1 with the average of raters 2 & 3 and TAI-Q. Intrarater reliability was assessed by rater 1 completing another TAI by watching the recorded videos after a 4-week delay. Assessments were compared using paired sample t-tests and level of agreement between TAI scores was evaluated using Bland-Altman plots.

RESULTS

Moderate to good interrater and good intrarater reliability were found for the total TAI score with ICCs: 0.57-0.90 and 0.90, respectively. Moderate to good intrarater and interrater reliability were found for all TAI subscores (ICC: 0.60-0.94) except for interrater reliability of flight/landing which was poor (ICC: 0.20). Bland-Altman plots indicate no systematic bias related to the measurement of error.

CONCLUSIONS

The TAI is a reliable outcome measure for assessing the wheelchair and body setup phases of home-based transfers remotely and through self-assessment among individuals with SCI.

Acceptability of Telerehabilitation for Magnification Devices for the Visually Impaired Using Various Approaches to Facilitate Accessibility

Purpose

We examined different methods to reduce the burden of accessing technology for videoconferencing during telerehabilitation for magnification devices for the visually impaired.

Methods

During telerehabilitation studies over the past 5 years, vision rehabilitation providers assessed and gave training to visually impaired participants with newly dispensed magnification devices at home who connected to Zoom videoconferencing via loaner tablets or smartphones with assistance from (phase 1; n = 10) investigators by phone, (phase 2; n = 11) local Lions Club volunteers in participants’ homes, or (phase 3; n = 24) remote access control software in a randomized controlled trial with 13 usual care controls who received in-office training. All participants completed the same post-telerehabilitation phone survey.

Results

A significantly greater proportion of phase 3 subjects indicated they strongly or mostly agreed that the technology did not interfere with the session (96%) compared to phase 1 (60%; 95% confidence interval [CI], 1.2–12.5; P = 0.03) or phase 2 (55%; 95% CI, 1.8–188; P = 0.01). The majority indicated telerehabilitation was as accurate as in person (68%), they were comfortable with telerehabilitation (91%) and interested in a future session (83%), and their magnifier use improved (79%), with no significant differences in these responses between phases (all P > 0.10), including comparisons of participants randomized to telerehabilitation or in-office training in phase 3 who reported similar overall satisfaction levels (P = 0.84).

Conclusions

Participants across all phases reported high levels of acceptance for telerehabilitation, with least interference from technology using remote access control in phase 3.

Translational Relevance

With accommodations for accessibility to videoconferencing technology, telerehabilitation for magnification devices can be a feasible, acceptable, and valuable option in countries with resources to support the technology.

Development of a Home-Based Telerehabilitation Service Delivery Protocol for Wheelchair Seating and Mobility Within the Veterans Health Administration

INTRODUCTION

The provision of seating and wheeled mobility devices is a complex process that requires trained professionals and multiple appointments throughout the service delivery process. However, this can be inconvenient and burdensome for individuals with mobility limitations or for individuals who live in rural areas. Rural areas often present unique difficulties regarding the provision of healthcare services including lengthy travel times to medical facilities and lack of specialized providers and medical technology. The purpose of this article is to provide a comprehensive overview of the development and implementation of a service delivery protocol for a home-based telerehabilitation assessment for wheelchair seating and mobility.

MATERIALS AND METHODS

The telerehabilitation team consists of a trained wheelchair seating and mobility therapist and a telehealth clinical technician (TCT). In order to determine veterans that are appropriate for a home-based telerehabilitation assessment, a three-phase pre-assessment screening process was conducted by the therapist and TCT, including consult, chart, and phone review. Veterans that met all of the predetermined eligibility criteria were recommended for a telerehabilitation wheelchair assessment. The TCT traveled to the veteran's residence with necessary evaluation and safety equipment and connected with the therapist remotely using the VA Video Connect platform. Assessment and veteran data were collected during the initial evaluation and then during a 21-day follow-up.

RESULTS

Forty-three veterans were successfully seen via telerehabilitation for a seating and wheeled mobility assessment between November, 2017 and July, 2018. The average travel distance between the veteran's residence and the clinic was 34.1 miles. The total telerehabilitation encounter times ranged from 45 min to 145 min.

CONCLUSIONS

The implementation of this service delivery protocol for wheelchair seating and mobility assessments demonstrated the benefits of using telehealth services including reaching rural veterans, reducing distance traveled, maximizing efficiency of provider schedules, and conducting realistic assessments in veterans' home environments. Success can be attributed to being able to deliver best practice remotely and to the rapport of the TCT with the providers. Cultivating provider buy-in, selecting appropriate outcome measures, and restructuring workflows were additional lessons learned. The VA Video Connect platform is an accessible tool that can be easily learned by both veterans and providers and used beyond initial wheelchair seating evaluations for improved access to follow-up healthcare services.