Functional Mobility Outcomes in Telehealth and In-Person Assessments for Wheeled Mobility Devices
Keywords:Assessment, Evaluation, Functional mobility, Telehealth, Wheeled mobility device
The purpose of this study was to compare telehealth and in-person service delivery models for wheeled mobility devices in terms of functional outcomes. We hypothesized that clinically significant improvements in functional mobility measured by the Functional Mobility Assessment (FMA) will occur in individuals receiving both telehealth and in-person clinic evaluations. A total of 27 Veterans receiving telehealth visits were compared to 27 individuals seen in clinic, selected from a database, matching for age, gender, and primary diagnosis. All mean individual item and total FMA scores in both groups increased from Time 1 to Time 2. Within the telehealth group, all changes in individual item and total FMA scores were statistically significant, with changes in 8 of 10 items meeting threshold for clinical significance (change >1.85 points). Within the clinic group, changes in 7 of 10 individual items and total FMA scores were statistically significant, and these same 7 items met threshold for clinical significance. Change scores for individual item and total FMA scores did not differ significantly between the two groups. A larger and clinically significant change in transfer score was seen in the telehealth group, suggesting telehealth visits may confer an advantage in being able to assess and address transfer issues in the home.
Arledge, S., Armstrong, W., Babinec, M., Dicianno, B.E., Digiovine, C., Dyson-Hudson, T., & Stogner, J. (2011). RESNA Wheelchair Service Provision Guide. Rehabilitation Engineering and Assistive Technology Society of North America. Retrieved from https://www.resna.org
Batavia, M., Batavia, A.I. & Friedman, R. (2001). Changing chairs: Anticipating problems in prescribing wheelchairs. Disability and Rehabilitation, 23(12), 539–548. https://doi:10.org/1080/09638280010022531
Cooper R, Trefler E, & Hobson DA. (1996). Wheelchairs and seating: Issues and practices. Technology and Disability, 5(1), 3-16. https://doi.org/10.3233/TAD-1996-5102
Cooper, R., Fitzgerald, S., Boninger, M., Cooper, R. A., Shapcott, N., Cohen, L., & Schmeler, M.R. (2002). Using telerehabilitation to aid in selecting a wheelchair. Rehabilitation Engineering & Assistive Technology Society of North America Annual Conference Proceedings, Minneapolis, Minnesota, 327-329.
Dallolio, L., Menarini, M., China, S., Ventura, M., Stainthorpe, A., & Soopramanien, A. (2008). Functional and clinical outcomes of telemedicine in patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 89(12), 2332-2341. https://doi.org/10.1016/j.apmr.2008.06.012
Ekeland, A.G., Bowes, A., & Flottorp, S. (2010). Effectiveness of telemedicine: A systematic review of reviews. International Journal of Medical Informatics, 79(11), 736-771. https://doi.org/10.1016/j.ijmedinf.2010.08.006
Erickson, W., Lee, C., & von Schrader, S. (2019). 2017 Disability Status Report: United States. Cornell University. Retrieved from www.disabilitystatistics.org
Gill, T.M., Allore, H.G., Hardy, S.E., & Guo, Z. (2006). The dynamic nature of mobility disability in older persons. Journal of the American Geriatrics Society, 54(2), 248-254. https://doi.org/10.1111/j.1532-5415.2005.00586
Graham, F., Boland, P., Grainger, R. & Wallace, S. (2019). Telehealth delivery of remote assessment of wheelchair and seating needs for adults and children: A scoping review. Disability and Rehabilitation, [published online ahead of print, 2019 Apr 23]. https://doi.org/10.1080/09638288.2019.1595180
Grenier, Kaila (2018). Veteran and provider satisfaction of a home-based telerehabilitation assessment for wheelchair seating and mobility. [Unpublished Master's Thesis}. University of Pittsburgh.
Hatzakis, M., Haselkorn, J., Williams, R., Turner, A., & Nichol, P. (2003). Telemedicine and the delivery of health services to veterans with multiple sclerosis. Journal of Rehabilitation Research and Development, 40(3), 265-282.
He, W. & Larsen, L.J. (2014). U.S. Census Bureau, American Community Survey Reports, ACS-29. Older Americans with a Ddsability: 2008–2012. Retrieved from https://www.census.gov/library/publications/2014/acs/acs-29.html, accessed on October 31, 2020.
Hoenig H, Landerman LR, Ship KM, Pieper C, & Richardson M. (2005). A clinical trial of rehabilitation expert clinician versus usual care for providing manual wheelchairs. Journal of the American Geriatric Society, 53(10), 1712-20. https://doi.org/10.1111/j.1532-5415.2005.53502.x
Kumar, A., Schmeler, M.R., Karmarkar, A.M., Collins, D.M., Cooper, R., Cooper, R.A., Shin, H., & Holm, M.B. (2013). Test-retest reliability of the functional mobility assessment (FMA): A pilot study. Disability and Rehabilitation Assistive Technology, 8(3), https://doi.org/10.3109/17483107.2012.688240
Malagodi, M., Schmeler, M.R., Shapcott, N.G., & Pelleschi, T. (1998). The use of telemedicine in assistive technology service delivery: Results of a pilot study. Technology Special Interest Section Quarterly, 8(1), 1-4.
O'Day, B., Dautel, P., & Scheer, J. (2002). Barriers to healthcare for people with mobility impairments. Managed Care Quarterly, 10(3), 41-51.
Okoro, C.A., Hollis, N.D., Cyrus, A.C., & Griffin-Blake, S. (2018). Prevalence of disabilities and health care access by disability status and type among adults - United States 2016. MMWR Morb Mortal Wkly Rep, 67:882–887. https://doi.org/10.15585/mmwr.mm6732a3
Paulisso, D.C., Schmeler, M.R., Schein, R.M., Allegretti, A.L.C., Campos, L.C.B., Costa, J.D. Fachin-Martins, E., & Cruz, D.M.C.D. (2019). Functional Mobility Assessment is reliable and correlated with satisfaction, independence and skills. Assistive Technology. Published online 2019 Jun 17. https://doi.org/10.1080/10400435.2019.1629125
Rosso, A.L., Taylor, J.A., Tabb, L.P., & Michael, Y.L. (2013). Mobility, disability, and social engagement in older adults. Journal of Aging and Health, 25(4), 617-637. https://doi.org/10.1177/0898264313482489
Sabharwal, S., Mezaros, M., & Duafenbach, L. (2001). Telerehabilitation across the continuum of care for individuals with spinal cord injury. Paper presented at the Proceedings of the State of the Science Conference on Telerehabilitation.
Schein, R.M., Schmeler, M.R., Holm, M.B., Saptono, A., & Brienza, D.M. (2010). Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91(6), 874-878. https://doi.org/10.1016/j.apmr.2010.01.017
Schmeler, M.R., Schein, R.M., Saptono, A., & Schiappa, V.J. (2019). Development and implementation of a wheelchair outcomes registry. Archives of Physical Medicine and Rehabilitation, 100(9), 1779-1781. https://doi.org/10.1016/j.apmr.2019.03.007
Schmeler M.R. (2005). Development and testing of a clinical outcome measurement tool to assess wheeled mobility and seating interventions [Dissertation]. University of Pittsburgh.
U.S. Department of Veterans Affairs. (2016). VA Telehealth Services [Fact Sheet]. Retrieved from https://www.va.gov/COMMUNITYCARE/docs/news/VA_Telehealth_Services.pdf, accessed on October 31, 2020.
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