Primary Objective: The overarching goal of the proposed research project is to study technology for Real Time Tele Video (RTTV), ascertaining its ability to meet basic physical therapy (PT) and occupational therapy (OT) needs (displaying movement, the physical surroundings, and the patient-environmental interface). Specific Objectives: We will determine the effects of currently available teletechnology on (a) reliability, (b) validity and (c) overall quality for standard measures used by PTs and OTs to assess physical function (e.g., fine motor coordination, gross motor coordination and spatial relationships. We hypothesize that the following technological parameters will affect measurement accuracy for standard measures of physical function: (1) internet bandwidth, (2) camera settings (e.g., camera resolution, stereoscopic lenses, etc.), and (3) programming parameters (e.g., refresh rate, compression algorithms, etc.) These specific objectives and hypotheses will be examined through 3 sequential sub-studies. Anticipated Outcomes: A better understanding of the ability of existing teletechnology to meet typical rehabilitation clinical needs will help ensure optimal use of extant technology and will uptake by OTs and PT, availability of which is particularly limited in rural locations. The results will help VHA Office of Telehealth determine the best types of telehealth equipment to deploy to meet specific clinical needs and will provide guidance to engineers developing new technology. Study Design: Repeated Measures to compare performance under different technological configurations. Study Sample: 3 convenience samples with 50 ambulatory veterans each (150 total) who have diverse mobility disorders (e.g., musculoskeletal, neurological). Teletechnology Configurations: (1) internet bandwidth, testing the Internet bandwidth range typical of VA and home internet connections (e.g., 64, 384 and 768 kps).; (2) camera parameters which differ in ability to capture spatial relationships and camera resolutions typical of currently used televideo technology (e.g., 320X240, 1280X720, 1920X1080), and (3) programming to optimize accurate measurement according to type of physical function while minimizing needed bandwidth (e.g., refresh rate, compression algorithms, transport protocol). Measurement under each configuration will be compared with in person OT/PT ratings (i.e., standard of care) and slow motion review of the videorecordings (i.e., gold standard criterion). Measures: Six standard clinical measures will be used that assess 3 different dimensions of physical function: (1) fine motor coordination; (2) gross motor coordination; and (3) spatial relationships (still and moving). In addition, the raters will provide a global assessment of image quality and human factors will be measured using the Rapid Assessment of Product Usability & Universal Design (RAPUUD). Analysis: Validity: An estimate of bias for each measurement will be obtained by both the difference and the absolute value of the difference between the gold standard and our sample estimates, and Mixed Models used to determine the effect sizes for various predictors of bias (e.g., technology). Reliability: The mixed model will estimate sources of variance from which intraclass correlations can be derived. Power: A sample size of 50 provides adequate precision in making these comparisons (e.g., the 95% CIs for reliabilities of 0.8 are 0.67 - 0.88 and for validities, we will have 80% power to detect standardized differences (SD) of 0.40 or greater between our gold standard and results of the different technological configurations. Replication: We will replicate tests of solutions from Sub-study 3 using 3-G wireless Internet with a convenience sample of 10 homes located in urban and rural areas in North Carolina, which will verify functionality under the variable bandwidth typical of wireless Internet required for RTTV in the home. Our Singapore collaboration allows for future replication in another country with a differing Internet system.
The Secretary for Veterans Affairs identified telehealth as a critical element in his Strategic Pla. Teletechnology may allow persons with chronic illness to stay at home longer. It also can be used to provide cutting-edge specialty care in rural areas. Occupational and Physical Therapy (OT/PT) is especially limited in rural locations. Teletechnology has enormous potential to meet this need, but it is underused by OT/PT. The proposed study will provide information needed to ensure proper, safe use of currently available Real Time Tele Video (RTTV) technology by OT/PT. The results will help VHA Office of Telehealth determine the best types of telehealth equipment to deploy to meet specific clinical needs. Last, but not least, it will help guide engineers developing technology to better meet clinical needs.
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