Tess Worboys1, Melinda Brassington2, Elizabeth Ward3, Petrea Cornwell4
1 Occupational Therapy, Charleville Hospital, South West HHS, PO Box 219, Queensland, 4470, firstname.lastname@example.org
2 Occupational Therapy, Charleville Hospital, South West HHS, PO Box 219, Queensland, 4470, email@example.com
3 Centre for Functioning and Health Research, Metro South HHS and The University of Queensland, PO Box 6053, Buranda, Queensland, 4102, firstname.lastname@example.org
4 Allied Health Research Collaborative, Metro North HHS, and Menzies health Institute of Queensland, Griffith University, 627 Rode Rd, Chermside, Queensland, 4032, Petrea.email@example.com
Background: Injuries to the upper limb are amongst the most common to the body, accounting for approximately 50% of all injuries. For individuals living in rural and remote areas, access to specialist services for hand surgery and initial rehabilitation often requires travel to metropolitan or larger regional centres. Telehealth offers a solution to assist delivery of Occupational Therapy (OT) services for hand therapy in rural and remote locations, however there is currently no evidence to validate this service. The current study aimed to determine the level of agreement between a Telehealth OT (T-OT) and a Face-to-face OT (FTF-OT) during a hand assessment and treatment session and explore patient and clinician satisfaction.
Methods: Participants were recruited from the cohort of adult patients referred with a hand injury to the OT Department of Charleville, St. George and Roma Hospitals, within the South West Hospital and Health Service. Eighteen (18) patients were assessed simultaneously by a T-OT and FTF-OT via videoconferencing. An Allied health assistant (AHA) assisted with the collection of objective measures at the patient end. Clinicians assessed patients across a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between T-OT and FTF-OT was set at ≥ 80%.
Results: Level of agreement for all objective measures (dynamometer/pinch gauge reading, goniometer flexion, goniometer extension, circumference in millimetres) ranged between 82-100%PEA. Clinician judgements for scar and general limb observations were 82-100%PEA. Assessment of exercise compliance showed 80-100%PEA. Documentation of patient’s pain severity and sensitivity location were 100%PEA. Ratings of activities of daily living (QuickDASH) was 89%PEA. The multiple Global Ratings of Change scales (GROC) collected were ≥95%PEA. Patient and clinician satisfaction was high. There were 3 instances where visual issues impacted the session.
Discussion: Clinical decisions made via telehealth were comparable to a traditional clinical session model. Consumers were also satisfied, therefore supporting the potential for implementing a telehealth model of hand therapy in a regional/rural setting.