The purpose of this project was to determine the effectiveness of a telerehabilitation (TR) consultation model to prescribe and procure an appropriate wheeled mobility and seating (WMS) device at a remotely located site. The availability of practitioners with specific expertise in this area was limited particularly in Westerns Pennsylvania. A telerehabilitation service delivery model was developed for a series of studies based on a current model implemented at the Center for Assistive Technology at the University of Pittsburgh Medical Center (CAT-UPMC). In a multi-center non-randomized clinical trial, 96 participants were evaluated: 50 In-Person (IP) at the CAT-UPMC and 46 TR participants at remote sites. The performance-based Functioning Everyday with a Wheelchair-Capacity (FEW-C) tool demonstrated excellent inter-rater reliability coefficients (ICC 2,k = 0.91) and good internal consistency measured by Cronbachs alphas with correlations ranging between 0.82 to 0.91 among the 46 TR participants. Results indicated that using a TR consultation model, a significant improvement in mean differences was observed for the each of the self-report Functioning Everyday with a Wheelchair (FEW) items and for the average FEW scores at the remotely sites. Effect size calculations indicated that nine of the ten items on the FEW as well as the total FEW had very large effect sizes using Cohens d, indicating the effectiveness of not only the new WMS device but the TR assessment as well. A significant relationship was found between the self-report FEW and performance-based FEW-C tools at baseline measured by Spearman rhos correlations. A significant difference was found for participants previous WMS device evaluation and prescription process compared to their current TR WMS device evaluation and prescription scores as well as patient satisfaction regarding the impact of the technology. The findings based on confidence intervals of post FEW scores indicated that TR was non-inferior to the standard IP care at CAT-UPMC. Telerehabilitation services resulted in decreased travel for participants, improved access to specialized services, education benefits for generalist practitioners, and service stabilization at the remote sites. A TR consultation model offers new alternative and effective opportunities to provide rehabilitation services in clinical settings, especially in rural or underserved locations.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04172009-090925 |
| Date | 05 June 2009 |
| Creators | Schein, Richard Michael |
| Contributors | Michael Pramuka, Mary Jo Geyer, Kendra Betz, Margo Holm, Mark Schmeler, David Brienza |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04172009-090925/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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