Functional Mobility Outcomes in Telehealth and In-Person Assessments for Wheeled Mobility Devices

Authors

  • Mitchell Bell
  • Richard M. Schein Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA http://orcid.org/0000-0002-9059-9672
  • Joseph Straatmann Joseph Straatmann is an occupational therapist specializing in wheelchair, seating and mobility evaluations at the University of Pittsburgh Medical Center in the Center for Assistive Technology and an Adjunct Clinical Instructor in the Department of Rehabilitation Science & Technology. He graduated from Belmont University in Nashville, Tennessee with his Doctorate in Occupational Therapy. His teaching responsibilities are in assistive technology applications and service delivery.
  • Brad E. Dicianno Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA http://orcid.org/0000-0003-0738-0192
  • Mark R. Schmeler Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA http://orcid.org/0000-0001-8173-5452

DOI:

https://doi.org/10.5195/ijt.2020.6335

Keywords:

Assessment, Evaluation, Functional mobility, Telehealth, Wheeled mobility device

Abstract

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.

  

Author Biographies

Richard M. Schein, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA

Richard M. Schein is a Research Health Scientist within the Department of Rehabilitation Science & Technology at the University of Pittsburgh. He received his Masters of Science in Rehabilitation Technology, a Masters of Public Health in Health Policy and Healthcare Management, and Doctorate of Philosophy in Rehabilitation Science all at the University of Pittsburgh. Schein interacts with various levels within or outside the University including Principal Investigators and collaborators, Directors, and Department Heads serving as an investigator and manager in the conduct of research projects, solving problems, coordinating projects & budgets, and day-to-day operations.

Brad E. Dicianno, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA

Dr. Dicianno is the Medical Director of the UPMC Center for Assistive Technology, Director of the UPMC Adult Spina Bifida Clinic, Medical Director and COO of the Human Engineering Research Laboratories, and Medical Director of the VA Center of Excellence on Wheelchairs and Associated Rehabilitation Engineering. His clinical interests are in the areas of spina bifida and assistive technology. His research interests focus on developing and studying interventions targeted to improving health and wellness in individuals with complex disabilities (such as wheelchairs, mobile health, and preventative care programs).

Mark R. Schmeler, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA

Mark Schmeler is the Vice Chair for Education & Training and an Associate Professor in the Department of Rehabilitation Science & Technology at the University of Pittsburgh. He oversees all aspects of the Master of Science curriculum in Rehabilitation Technology. Schmeler has 30 years of clinical experience and continues to practice as an Occupational Therapist and Assistive Technology Professional in the Center for Assistive Technology at the University of Pittsburgh Medical Center which he helped establish in 1996. His research interests include the application of telerehabilitation, product development, functional outcomes, and online education

References

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.

Published

2020-12-08

How to Cite

Bell, M., Schein, R. M., Straatmann, J., Dicianno, B. E., & Schmeler, M. R. (2020). Functional Mobility Outcomes in Telehealth and In-Person Assessments for Wheeled Mobility Devices. International Journal of Telerehabilitation, 12(2), 27–34. https://doi.org/10.5195/ijt.2020.6335

Issue

Section

Original Research

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