Objective: To determine whether conditions for use of clinical video telehealth technology might affect the accuracy of measures of physical function. Design: Repeated measures. Setting: Veterans Administration Medical Center. Participants: Three healthy adult volunteers for a sample size of n=30 independent trials for each of 3 physical function tasks. Interventions: None. Main Outcome Measures: Three tasks capturing differing aspects of physical function: fine-motor coordination (number of finger taps in 30s), gross-motor coordination (number of gait deviations in 10ft [3.05m]), and clinical spatial relations (identifying the proper height for a cane randomly preset ±0-2in [5.1cm] from optimal), with performance simultaneously assessed in person and video recorded. Interrater reliability and criterion validity were determined for the measurement of these 3 tasks scored according to 5 methods: (1) in person (community standard), (2) slow motion review of the video recording (criterion standard), and (3-5) full speed review at 3 Internet bandwidths (64kps, 384kps, and 768kps). Results: Fine-motor coordination - Interrater reliability was variable (r=.43-.81) and criterion validity was poor at 64kps and 384kps, but both were acceptable at 768kps (reliability r=.74, validity β=.81). Gross-motor coordination - Interreliability was variable (range r=.53-.75) and criterion validity was poor at all bandwidths (β=.28-.47). Motionless spatial relations - Excellent reliability (r=.92-.97) and good criterion validity (β=.84-.89) at all the tested bandwidths. Conclusions: Internet bandwidth had differing effects on measurement validity and reliability for the fine-motor task, the gross-motor task, and spatial relations, with results for some tasks at some transmission speeds well below acceptable quality standards and community standards.
Hoenig, H., Tate, L., Dumbleton, S., Montgomery, C., Morgan, M., Landerman, L. R., & Caves, K. (2013). A quality assurance study on the accuracy of measuring physical function under current conditions for use of clinical video telehealth. Archives of Physical Medicine and Rehabilitation, 94(5), 998–1002. https://doi.org/10.1016/j.apmr.2013.01.009