Testing the validity and reliability of a replicable tele-monitored physical fitness battery that is inclusive of adults with and without disabilities (Preprint)

Abstract

Clinical assessments of therapeutic exercise studies are typically not designed to be translated into the home or community and fall short of reaching confirmatory study samples.

The first aim was to explore the feasibility of conducting tele-assessments for early adults with and without disabilities via metrics of implementation: duration of the assessments, technical usability issues. The second aim was to establish a statistically appropriate level of agreement between the tele- and in-person exercise assessments (convergent validity). The third aim was to establish a statistically appropriate level of inter rater agreement for each tele-assessment between two independent raters.

This cross-sectional study enrolled 18 people: 9 youth with disabilities from a Children’s Hospital, and 9 youth without disabilities from a University student population, which was matched for age (aged 15-24 years), sex, and weight. Participants were randomized to perform a battery of functional assessments either via tele-assessment (performed onsite at the laboratory) or via in-person supervision. Participants completed a handgrip strength test with each hand, the Five Times Sit to Stand (FTST) test, the Timed Up and Go (TUG) test, and a 6 minute-walk test (either around a standard circular track [in-person] or around a smaller home-simulated track [tele-assessment]). Descriptive analyses and intraclass correlation coefficients (ICC) were used to examine agreement between the the two types of tests and raters on the tele-assessment tests.

The mean time to complete the tele-assessment battery was 21.7 ± 5.4 and the in-person assessments was 17.3 ± 4.7 mins. Excellent descriptive and statistical agreement between tele-assesment and in-person assessments was demonstrated for hand grip strength (right ICC=0.96 ; left ICC=0.98), and the Timed Up and Go (ICC=0.96); good agreement for the FTST test (ICC=0.83). The tele-assessment 6MWT demonstrated excellent agreement (ICC=0.91) with in-person distance using a conversion factor of 10.85 meters per tele-assessment lap. However, the Bland-Altman Plot demonstrated poor agreement for the tele-assessment to either underestimate or overestimate walking distances compared to those obtained in-person.

Study findings demonstrated that a simple tele-assessment battery can be used to assess physical fitness and function among ambulatory youth with and without disabilities. The battery has strong psychometric properties, but notable limitations, which warrant further investigation. This study is a first step towards developing tele-assessments that can bypass the need for onsite data collection vistations for this age group.