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Equivalence of Face-to-face and Videoconference Administration of Functional Communication Measures for Post-Stroke Patients Sue Palsbo, PhD National Rehabilitation Hospital/George Mason University Robert Mullen, MPH Tobi Frymark, MA, CCC-SLP American Speech-Language Hearing Association Pamela G. Forducey, PhD, ABPP INTEGRIS Neuroscience Institute and Telehealth Funding Robert Wood Johnson Foundation, Methodologies Grant, #49143 US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR), Rehabilitation Engineering and Research Center (RERC) on Telerehabilitation #H133E990007-00C RERC on Telerehabilitation Study Partners Professional Association American Speech-Hearing Language Association (ASHA) Rehabilitation Hospitals INTEGRIS/Jim Thorpe (Oklahoma) National Rehabilitation Hospital (Washington DC) Goal Determine if a post-stroke functional communication assessment tendered by a remote therapist is equivalent to a face-to-face assessment. Criteria for Selecting Measures (1) Be appropriate and relevant to people with stroke. (2) Have known psychometric properties (validity and reliability) published in peerreviewed literature. (3) Wide use in research and clinical practice. (4) Be visually based (that is, the therapist can measure using televideo without touching the patient). (5) All measures can be completed within 30 minutes. Design Issues for Measuring Equivalence Serial correlation bias Inter-rater reliability Measure simultaneously, not serially Use measurement tools with published reliability values Training Bias in administration Switch off the therapist conducting the assessment Randomization Site #1 Site #2 Face-toface admin 6 6 Remote admin 6 6 Total: 24 paired observations Functional Communication Measures Motor speech Speech comprehension Speech expression FCM : Spoken Language Expression Level 1: Individual attempts to speak, but verbalizations are not meaningful to familiar or unfamiliar communication partners at any time. Level 4: Individual successfully able to initiate communication using spoken language in simple, structured conversations in routine daily activities with familiar communication partners. Individual occasionally requires moderate cueing, but is able to demonstrate use of simple sentences (i.e., semantics, syntax, and morphology) and rarely uses complex sentences/messages). Level 7: Individual’s ability to successfully and independently participate in vocational, avocational, and social activities is not limited by spoken language skills. Independent functioning may occasionally include use of self-cueing. The Data Speech Comprehension On-site Remote On-site Remote On-site administration NRH1 5 6 JTSLP1 5 6 NRH3 5 5 JTSLP2 6 6 NRH5 7 5 JTSLP3 5 5 NRH6 6 5 JTSLP4 6 7 NRH9 7 7 JTSLP5 6 5 NRH11 5 5 JTSLP6 7 7 Remote administration NRH2 3 5 JTSLP7 6 5 NRH4 4 5 JTSLP8 6 7 NRH7 4 5 JTSLP9 7 6 NRH8 4 5 JTSLP10 4 3 NRH10 6 5 JTSLP11 6 5 NRH12 7 7 JTSLP12 4 3 ICC for Speech Assessment Motor speech Administration Face-to-face Remote ICC sig. ICC 0.828 0.051 0.828 0.242 0.366 0.667 sig. 0.047 0.077 Speech Comprehension Administration Site Face-to-face Remote ICC sig. ICC NRH 0.545 0.214 0.737 Integris 0.762 0.084 0.872 sig. 0.062 0.010 Site NRH Integris Speech Expression Site NRH Integris Administration Face-to-face Remote ICC sig. ICC 0.733 0.080 0.844 0.906 0.015 0.837 sig. 0.042 0.025 Raw Agreement Index Percent agreement Exact within 1 Motor speech 46% 96% Speech comprehension 26% 91% Speech expression 38% 96% Conclusions and Improvements Not clear why the percentage exact agreement was low, and the agreement within 1 score was high Additional randomizing of SLPs would have allowed us to control for one person who appeared to consistently score lower Scoring might have been more consistent if we had selected activities that are a better fit with the FCMs we selected Future Research Televideo assessments are worth pursuing Need to look at POTS videophones Need to develop clinical protocols (positioning camera; patient safety; appropriate candidates) Need to identify more continuous measurement scales and demonstrate equivalence Maintain movement toward RCTs of teletherapy