Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services
Shelley E. Keating, Amandine Barnett, Ilaria Croci, Amy Hannigan, Louise Elvin‐Walsh, Jeff S. Coombes, Katrina L. Campbell, Graeme A. Macdonald, Ingrid J. Hickman
Abstract
To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. Reliability study: repeated-measure, within-subject design. Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments. Not applicable. The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [−2.2 to 3.6kg]; waist 0.4 (−1.2 to 2.0) cm [−5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [−19.4 to 34.9mmHg]; DBP 2.4 (−1.4 to 6.2 ) mmHg [−12.2 to 17.0mmHg]; 6MWT, 7.5 (−29.1 to 44.1) m [−127.3 to 142.4m]; STST 0.5 (−0.8 to 1.7) seconds [−4.3 to 5.3s]; maximal push-ups −2.2 (−4.4 to −0.1) [−10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement. Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.