Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic

Objective: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. Design: Repeated-measures study design. Participants: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. Intervention: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. Main outcome measures: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. Results: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58–0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. Conclusion: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Background: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Methods: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Results: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). Conclusions: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.</p

Does the signal-to-noise ratio of an interlocutor influence a speaker's vocal intensity?

This study investigated whether the signal-to-noise ratio (SNR) of the interlocutor (speech partner) influences a speaker's vocal intensity in conversational speech. Twenty participants took part in artificial conversations with controlled levels of interlocutor speech and background noise. Three different levels of background noise were presented over headphones and the participant engaged in a “live interaction” with the experimenter. The experimenter's vocal intensity was manipulated in order to modify the SNR. The participants’ vocal intensity was measured. As observed previously, vocal intensity increased as background noise level increased. However, the SNR of the interlocutor did not have a significant effect on participants’ vocal intensity. These results suggest that increasing the signal level of the other party at the earpiece would not reduce the tendency of telephone users to talk loudl

Does the signal-to-noise ratio of an interlocutor influence a speaker's vocal intensity?

This study investigated whether the signal-to-noise ratio (SNR) of the interlocutor (speech partner) influences a speaker's vocal intensity in conversational speech. Twenty participants took part in artificial conversations with controlled levels of interlocutor speech and background noise. Three different levels of background noise were presented over headphones and the participant engaged in a “live interaction” with the experimenter. The experimenter's vocal intensity was manipulated in order to modify the SNR. The participants’ vocal intensity was measured. As observed previously, vocal intensity increased as background noise level increased. However, the SNR of the interlocutor did not have a significant effect on participants’ vocal intensity. These results suggest that increasing the signal level of the other party at the earpiece would not reduce the tendency of telephone users to talk loudl

Developing tests of impaired coordination for Paralympic classification: normative values and test–retest reliability

Current methods of assessing coordination in Paralympic classification are non-instrumented and are based on ordinal scales of measurement and therefore impede the development of evidence-based methods of classification. This paper describes an instrumented battery of tests that measure impaired coordination in a way that will permit evidence-based classification. Test–retest reliability and normative values for each of the tests are reported. Twenty participants visited the laboratory on two occasions, each time completing 11 tests: three running-specific, lower-limb reciprocal tapping tests (yielding five outcome measures); four throwing-specific, upper-limb discrete tapping tests (yielding four outcome measures); and four wheelchair-specific, upper-limb reciprocal tapping tests yielding seven outcome measures. Reliability was evaluated using Intra-class Correlation Coefficients (ICCs), Standard Error of Measurement, Limits of Agreement and Paired t-tests. ICCs for fourteen of the 16 outcome measures were excellent (ICC ≥ 0.80), although systematic bias was evident in two of these—a unilateral, running-specific lower-limb tests on the non-dominant side, and a unilateral wheelchair-specific upper limb test on the dominant side. ICCs for two tests—a bilateral wheelchair-specific upper limb test (0.74), and a unilateral wheelchair-specific upper limb test on the non-dominant side (0.54)—were good and fair respectively. Results indicate that 12 of the measures evaluated have measurement properties that will facilitate the development of evidence-based methods of Paralympic classification in athletics. Positional adjustment and increased familiarization may improve reliability in the other four. Studies evaluating reliability of this test battery in people with coordination impairments are warranted