In Patients Admitted to a Home Rehabilitation Service, Can a Physical Examination of Muscle, Fat, and Fluid Status be Completed Remotely Via Videocall? A Validation Study.

BACKGROUND: Teleconsultation via videocall by a dietitian may allow remote diagnosis of malnutrition amongst patients undertaking home rehabilitation; however, whether or not a physical examination can be performed accurately remotely has not yet been determined. OBJECTIVE: This study aimed to compare agreement between an in-person and videocall by a dietitian for overall physical assessment in patients admitted to a home rehabilitation service. DESIGN: This was a cross-sectional diagnostic accuracy study. PARTICIPANTS AND SETTING: This study involved 71 adults admitted to the home rehabilitation program at Flinders Medical Centre in Adelaide, South Australia, Australia, between September 2019 to November 2019 and August 2020 to November 2020. MAIN OUTCOME MEASURES: Validity of the videocall by a dietitian to undertake a physical assessment was determined using an in-person physical assessment completed by a trained dietitian in the participant's own home. A dietitian blinded to the in-person assessment completed the physical examination via a videocall to determine the presence and degree of deficit at each anatomical site and make an overall physical assessment. STATISTICAL ANALYSES PERFORMED: Percentage agreement, weighted kappa, sensitivity, and specificity were determined to assess agreement between videocall and in-person assessments undertaken by a dietitian. RESULTS: The overall videocall physical examination by a dietitian rating achieved a percentage agreement of 69.0% against the in-person assessment by a dietitian, with a weighted kappa agreement of 0.658 (95% CI 0.530 to 0.786), sensitivity of 87.5%, and specificity of 81.1%. CONCLUSIONS: The substantial weighted kappa, good sensitivity, and specificity supports the use of the physical assessment in contributing to diagnosing malnutrition via videocall in home rehabilitation settings. Services that are without a local dietetic workforce should consider using dietitians to undertake videocalls for the physical examination component of nutrition assessment to facilitate timely nutrition assessment and optimal nutrition interventions, as well as support review of nutrition interventions.

In Patients Admitted to a Home Rehabilitation Service, Is Remote Completion of the Patient-Generated Subjective Global Assessment Physical Examination Using Still Images Captured by Allied Health Assistants a Valid Alternative to an In-Person Physical Examination?

BACKGROUND: There is increasing provision of telehealth services, including nutrition services. However, remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status. OBJECTIVE: The aim of this study was to evaluate whether remote completion of the Patient-Generated Subjective Global Assessment physical examination using still images captured by allied health assistants (AHAs) is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service. DESIGN: This study was cross-sectional in design. PARTICIPANTS/SETTING: This study involved 104 adults admitted to the home rehabilitation service at Southern Adelaide Local Health Network, Adelaide, Australia, over 2 sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities. MAIN OUTCOME MEASURES: Validity of the still image-based physical assessment was determined using still images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-Generated Subjective Global Assessment. STATISTICAL ANALYSES PERFORMED: Percentage agreement, weighted κ, sensitivity, and specificity between the still image based and in-person physical examinations were determined to assess agreement between the 2 methods of assessment. RESULTS: The still image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted κ of 0.662 (95% confidence interval 0.516-0.808) and a sensitivity-specificity pair of 76.6% and 89.1%. CONCLUSIONS: Physical examination using still images collected by AHAs achieved percentage agreement, κ, and sensitivity and specificity compared with an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians; however, further work is needed to ensure dietitians are able to assess still images reliably.