A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities

Abstract

Objective: To evaluate the performance of telehealth as a screening tool for spasticity compared to direct patient assessment in the long-term care setting. Design: Cross-sectional, observational study. Setting: Two long-term care facilities: a 140-bed veterans’ home and a 44-bed state home for individuals with intellectual and developmental disabilities. Subjects: Sixty-one adult residents of two long-term care facilities (aged 70.1 ± 16.2 years) were included in this analysis. Spasticity was identified in 43% of subjects (Modified Ashworth Scale rating mode = 2). Contributing diagnoses included traumatic brain injury, spinal cord injury, birth trauma, stroke, cerebral palsy, and multiple sclerosis. Main measures: Movement disorders neurologists conducted in-person examinations to determine whether spasticity was present (reference standard) and also evaluated subjects with spasticity using the Modified Ashworth Scale. Telehealth screening examinations, facilitated by a bedside nurse, were conducted remotely by two teleneurologists using a three-question screening tool. Telehealth screening determinations of spasticity were compared to the reference standard determination to calculate sensitivity, specificity, and the area under the curve (AUC) in receiver operating characteristics. Teleneurologist agreement was evaluated using Cohen’s kappa. Results: Teleneurologist 1 had a specificity of 89% and sensitivity of 65% to identify the likely presence of spasticity ( n = 61; AUC = 0.770). Teleneurologist 2 showed 100% specificity and 82% sensitivity ( n = 16; AUC = 0.909). There was almost perfect agreement between the two examiners at 94% (kappa = 0.875, 95% CI: 0.640–1.000). Conclusion: Telehealth may provide a useful, efficient method of identifying residents of long-term care facilities that likely need referral for spasticity evaluation.