Hill ML (VA Palo Alto Health Care System), Cronkite RC
(VA Palo Alto Health Care System), Yao EC
(University of California Davis Medical Center), Ota DT
(VA Palo Alto Health Care System), Bacon SA
(VA Palo Alto Health Care System), Henderson PT
(VA Palo Alto Health Care System), Kiratli JB
(VA Palo Alto Health Care System)
Home telehealth—using technology to care for a patient at home when the provider is at a distance—has been practiced for monitoring pressure ulcers for more than a decade. Although numerous projects have demonstrated the utility of home telehealth videoconferencing for monitoring pressure ulcers in patients with spinal cord injury and disorder (SCI/D), no prior studies have demonstrated the reliability or validity of this technology for clinical assessment and diagnoses. This study evaluates reliability and validity of telemedicine by comparing assessments and diagnoses made via two telehealth approaches—telephone call and low-bandwidth audio-video connection—with those made by the "gold standard" in-person approach. In-person assessments and diagnoses were considered "correct" for statistical evaluation.
Forty-two adults diagnosed with SCI/D, with and without pressure ulcers, were recruited from patients treated at the VA Palo Alto HCS and within the local area. Sixty-seven skin/pressure ulcer assessments were conducted via telephone contact, videoconferencing, and in person. Three physical therapists performed the evaluations and were randomized regarding assessment approach for each session. Equivalency of evaluators was determined previously based on inter-rater reliability testing. Data analysis was performed using Spearman correlation for primary diagnosis data (Staging 0-4). Kappa coefficients, Landis Agreement Level, percent agreement, and sensitivity and specificity were used to determine agreement with presence/absence of wound stage and characteristics.
Both audio-video and telephone contact telehealth approaches demonstrated a substantial correlation with in-person assessment for the ordinal primary diagnosis of wound staging—correlation coefficients of 0.83 and 0.76, respectively. Videoconferencing demonstrated fair to substantial agreement levels for specific wound characteristics (except epithelialization); telephone contact yielded inferior agreement levels. There was an overall pattern of greater sensitivity with videoconferencing than telephone evaluations.
Telehealth videoconferencing provides a valid method to perform staging and assessment of some characteristics of pressure ulcers, but is limited in identifying wound healing. Telephone contact can detect the absence of wound/skin characteristics with reliability, but is not sufficient to reliably identify the presence of most wound characteristics.
Telehealth is a promising approach for assessing and monitoring pressure ulcers in SCI/D patients, and thus may enhance quality of care and cost-effectiveness.