Agreement between face-to-face and tele-assessment of physical function measurement after COVID-19 in non-hospitalized patients

Abstract

In this letter we shortly describe and discuss the level of agreement between face to face and tele-assessment of global physical functioning in patients after COVID-19. COVID patients have shown significant impairments in physical function that may persist up to 1 to 2 years post-infection. Nevertheless, those impairments seem to be under treated due the inability of the health agencies to handle the large increase in patient’s volume.1 Videoconferencing could reproduce a traditional in-person visit using a computer, tablet, or mobile device with access to high-speed internet. Patients confirmed SARS-CoV-2 infection, with an age over than 18 years, and with at least minimal experience using computers and free access to it were asked to participate in the study signing an informed consent, in accordance with the Declaration of Helsinki. Patients underwent two physical assessments in an appointment: a traditional face-to-face and a real-time online assessment. These evaluations were conducted by two physiotherapists; one therapist always conducted the face-to-face evaluation and the other the online assessment, and each was blinded to the assessments of the other. The two assessments were separated by 20 minutes and the order was randomized using a random sequence generator for each patient and examiner to counterbalance any testing order effects. Physiotherapist evaluated lower and upper limbs function, exercise capacity, and symptoms after exercise, as well as sociodemographic information, quality of life and videoconferencing satisfaction. Lower limbs function was assessed by the Short Physical Performance Battery (SPPB). It is an objective tool that measure three components: the ability to rise from a chair five times as quickly as possible, standing balance, and walking speed; higher scores indicated better function. To evaluate upper limbs function, participants were instructed to complete the maximal number of shoulder flexions with each arm in one minute holding a free weight in the hand (1 kg). Finally, participants were instructed to sit to stand from a chair as many full stands as possible in 30 seconds in order to assess exercise capacity. Dyspnea and fatigue were assessed after the test, with 0 being no shortness of breath or no fatigue, and 10 being shortness of breath or fatigue as bad as can be. Agreement between face-to-face and tele-assessment was analyzed applying the two-way random-effects intraclass correlation coefficient (ICC) (ρ) for the remainder of variables, and their confidence intervals were calculated for the interrater reliability trials. The 55 participants included were a mean age of 35.27 years that range from 18 to 66 years. The 27.27% of the sample were men with a mean Body Mass Index of 34.62. The mean time since infection was 3 months. The score of quality of life was 86.46 of 100 points. In addition, the mean score of the videoconferencing satisfaction was 30.27 of 35 points. All the measures evidence a very good interrater reliability (Table I). The highest reliability was obtained for the static balance, left upper limb function and fatigue after exercise. Table I —Interrater reliability between face-to-face and tele-assessment for lower limbs function, upper limbs function, exercise capacity and symptoms after exercise. Variables Evaluator 1 Evaluator 2 InterraterReliabilityICC (CI 95%) Lower limbs function 5STS 3.71±0.65 3.69±0.69 0.96 (0.94,0.98) Static balance 4.00±0.00 4.00±0.00 1.00 (-) Walking Speed 3.49±0.69 3.58±0.56 0.91 (0.85,0.95) Total 11.20±1.14 11.27±1.07 0.96 (0.93,0.97) Upper limbs function Right 33.94±8.29 33.98±8.34 0.99 (0.99,1.00) Left 34.24±8.68 34.25±8.66 1.00 (0.99,1.00) Exercise capacity 18.80±5.53 18.85±5.48 0.99 (0.99,0.99) Symprtoms after exercise Dyspnea 1.60±1.83 1.75±1.85 0.95 (0.92,0.97) Fatigue 2.29±2.52 2.29±2.52 1.00 (-) 5STS: Five-time Sit-To-Stand test; CI: confidence interval; ICC: Intraclass Correlation Coefficient. Data are expressed as mean±standard deviation. Our results are in line with other studies such as that of Hwang et al. 2017,2 that carried out a study to determine the validity and reliability of tele-assessments of exercise capacity in patients with heart failure. They concluded that the use of telehealth for the assessment of functional exercise capacity appears to be valid and reliable. In addition, Cabrera-Martos et al. 20193 carried out a study to evaluate the level of agreement between face-to-face and tele-assessment of upper limb function in patients with Parkinson Disease. They concluded that there was a high interrater reliability of upper limb tele-assessment in patients with Parkinson Disease compared to a face-to-face assessment. Therefore, telemedicine has the potential to be an effective tool for delivering more frequent and timely health care to people with chronic conditions at a distance, and for improving access to health care.4 Technological improvements and cost reduction of telemedicine solutions combined with both the high-speed internet and mass spread of smartphones makes it possible to apply this framework and quickly deploy video teleconsultations from a patient’s home.5 Future studies should evaluate the effectiveness of a complementary home-based intervention focused on improving the physical function including a follow-up using videoconference. The applicability of findings to clinical practice may be useful for patients whose access is limited by distance or clinical characteristics.