title: Validation of home telehealth for pressure ulcer assessment: a study in patients with spinal cord injury.
abstract: The reliability and validity of assessments and diagnoses made via home telehealth was measured in 42 patients with spinal cord injury. Two telehealth modalities were investigated: telephone-only contact and videoconferencing. The results were compared with a reference (gold-standard) method, the in-person assessment and diagnosis of skin integrity and pressure ulcers. The agreement on the presence of a pressure ulcer was excellent for both telephone and videoconferencing approaches (92% for telephone, 97% for videoconferencing). The diagnoses of the stage of pressure ulcer (on an ordinal scale of 0-4) made via telephone and videoconferencing showed substantial to almost perfect agreement with the in-person diagnoses (Spearman's rho of 0.76 and 0.83, respectively). There was a tendency for the measurements of wound volume to be somewhat larger in the telephone and videoconferencing modalities compared to those made in-person. Bland-Altman plots showed that videoconferencing gave substantially narrower 95% limits of agreement. The findings of the study indicate that telephone contact can be a useful tool for identifying the presence of a pressure ulcer, but videoconferencing is required to obtain an evaluation reasonably close to that of a home visit.
authors.affiliation: Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Hill
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Cronkite
authors.forename: Doug T
authors.initials: DT
authors.lastname: Ota
authors.forename: Elisa C
authors.initials: EC
authors.lastname: Yao
authors.forename: B Jenny
authors.initials: BJ
authors.lastname: Kiratli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications; D017216:Telemedicine / Q000379:methods* / Q000592:standards; D013689:Telephone / Q000592:standards*; D054928:Validation Studies as Topic; D049269:Videoconferencing / Q000592:standards*; D055815:Young Adult