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

Mitchell Bell,Joseph Straatmann,Richard M Schein,Mark R Schmeler,Brad E Dicianno

doi:10.5195/ijt.2020.6335

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.

Highlights

The purpose of this study was to compare telehealth and in-person service delivery models for wheeled mobility devices in terms of functional outcomes
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
This study demonstrated increases in all Functional Mobility Assessment (FMA) items and total score, regardless of whether the visit was conducted in clinic or via telehealth

Summary

Introduction

The purpose of this study was to compare telehealth and in-person service delivery models for wheeled mobility devices in terms of functional outcomes. In a descriptive case analysis of prescribed adaptive equipment, Malagodi et al (1998) concluded that differences between in-person and tele-wheelchair assessment were clinically insignificant based on a descriptive comparison of prescribed wheelchair/modifications Recent studies such as Dallolio et al (2008) used telehealth and standard care after patients were discharged from an inpatient spinal cord injury rehabilitation unit and noted some improvements in grooming, dressing and transfers for those receiving telehealth services at one site. Schein et al (2010) evaluated the equivalency of wheeled mobility and seating assessments delivered under two conditions: in-person at a local clinic and via telerehabilitation at a remotely located clinic He concluded that there was no difference in wheelchair user perceived function between tele and inperson wheelchair assessment measured by the Functioning Everyday with a Wheelchair (FEW) outcome tool except for the item of transportation

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Discussion

Conclusion