Reliability and validity of telerehabilitation
After receiving a $15,000 Pat Cosh Trust Grant in 2018, Peter Malliaras, and a team including Terry Haines, Shannon Munteanu and PhD student Fatmah Hasani, were able to investigate the reliability and validity of assessing exercise fidelity using easily accessible telerehabilitation technology.
Telehealth is becoming a real benefit for patients, not only for convenience but also for accessibility to healthcare when living in rural and remote regions. The technology has the potential to raise the distribution of healthcare resources and maximise convenience for consumers. ‘Telerehabilitation is really something that our clinicians are starting to use a lot more. The concept of telerehabilitation is where a physiotherapist, or any clinician, can remotely connect to a patient via teleconferencing technology,’ Peter explains. ‘We see the potential to allow access to expertise and the right care for people everywhere regardless of location, so it is bridging gaps in terms of provision of services.’
Peter says exercise fidelity is a fundamental aspect of exercise prescription by physiotherapists; however, the utility of assessing exercise fidelity via telerehabilitiation has not been assessed. Peter’s study aimed to develop a method that clinicians can trust for assessing whether the patients are doing their calf exercises, and whether they are undertaking it properly. The motivation was to encourage clinicians to be confident in using telerehabilitation for the assessment and management of patients with Achilles tendinopathy, that is, where the physiotherapist and the patient can be anywhere at any time and they can remotely connect via teleconferencing technology. Peter says ‘we are reliant on our assessment of patients, accurate assessment often via touch and also being able to view things accurately in person, and we were very conscious that you can’t just tell clinicians to go and assess people via telerehabilitation … we need to provide them with ways that are tested to be accurate in being able to assess patients via telerehabilitation.’
The Pat Cosh Trust Grant was important to enable Peter and the research team to hire a research assistant who organised the collection of data and recruited the physiotherapists to conduct the assessments. ‘We had a whole series of Achilles tendinopathy patients performing calf raises and we assessed them in person, but then we also took video of that assessment and gave them to the physiotherapists, two separate ones, and they assessed them at base line and then after a few weeks,’ Peter explains. ‘That allowed us to test the validity—so that was your physiotherapist assessment compared to our gold standard in-person assessment—and it also allowed us to test the reliability.’
A rating scale with six criteria was developed to assess calf raise exercise fidelity based on the current literature and input from eight specialist clinicians. Nineteen videos of patients with Achilles tendinopathy undertaking calf raise exercise in a seated and standing position were assessed by an experienced physiotherapist (real-time rating). Peter says ‘we looked at how smooth they were moving, the tempo in time with the metronome, whether they were going into the full range of motion … ankle dorsiflexion, plantar flexion … and whether they were doing the movement in the sagittal plane, or coming out of the sagittal plane.
‘Reliability and validity compared to the gold standard were moderate-to- excellent for all criteria; however, for the smooth and sagittal plane criteria, the inter- and intra-rated reliability were lower than some of the other criteria,’ Peter says.
This study was nested in a pilot feasibility randomised control trial, where the effects of different exercise intensities on Achilles tendinopathy outcomes were examined using telerehabilitation to try to maximise patient adherence and make sure they are being performed correctly. Peter says that a future larger study is now planned. ‘Another study we could do is to expand what we know now about valid and reliable telerehab measures in the ankle to other joints, for example, looking at shoulder assessment via telerehabilitation.’
Applications now open for Pat Cosh Trust Grants 2020 The Pat Cosh Trust was established to enable physiotherapists working or residing in Victoria to provide high-quality care to the general public. The purpose of the Trust is to improve the education of practitioners and students by initiating and supporting programs that improve their ability to practise, and funding research to improve their standard of education.
The Trustees are calling for applications for the 2020 round of grants. This year, one grant up to the value of $15,000 will be offered. For enquiries and how to apply, email email@example.com. Applications close Wednesday 6 November 2019 at 11:30 pm.
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