Unit 6 Assignment 2: Statistics Applied to Research Studies
Analyze these 3 co
elational, case, and cross-sectional research studies. Based on your findings, explain why these statistics are used. Total 1-2-page summary explaining these statistics in general words.
Co
elational study
Keating, S. E., Barnett, A., Croci, I., Hannigan, A., Elvin-Walsh, L., Coombes, J. S., ... & Hickman, I. J XXXXXXXXXXAgreement and reliability of clinician-in-clinic vs patient-at-home clinical and functional assessments: implications for telehealth services. Archives of Rehabilitation Research and Clinical Translation, XXXXXXXXXXhttps:
doi.org/10.1016/j.a
ct XXXXXXXXXX
Case-control study
Monaghesh, E., & Hajizadeh, A XXXXXXXXXXThe role of telehealth during COVID-19 out
eak: A systematic review based on cu
ent evidence. https:
doi.org/ XXXXXXXXXX
s.3.rs-23906/v3
Cross-sectional study
Ghaddar, S., Vatcheva, K. P., Alvarado, S. G., & Mykyta, L XXXXXXXXXXUnderstanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study. Journal of Medical Internet Research, 22(9), e21012. https:
doi:10.2196/21012
Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services
Archives of Rehabilitation Research and Clinical Translation XXXXXXXXXX, 100066
Archives of Rehabilitation Research and Clinical Translation
Archives of Rehabilitation Research and Clinical Translation 2020;2:100066
Available online at www.sciencedirect.com
Original Research
Agreement and Reliability of Clinician-in-
Clinic Versus Patient-at-Home Clinical and
Functional Assessments: Implications fo
Telehealth Services
Shelley E. Keating, PhD a,
Amandine Barnett, M Nut & Diet Practice b,c,
Ilaria Croci, PhD a,d, Amy Hannigan, BHSci (Nut & Diet) c,
Louise Elvin-Walsh, BHSci (Nut & Diet) c,
Jeff S. Coombes, PhD a, Katrina L. Campbell, PhD b,c,
Graeme A. Macdonald, PhD, MBBS e,f,g,
Ingrid J. Hickman, PhD c,h
a School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane,
Queensland, Australia
Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University,
Gold Coast, Queensland, Australia
c Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland,
Australia
d K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging,
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
e Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland,
Australia
f Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
g School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
h Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
List of a
eviations: 6MWT, 6-minute walk test; DBP, diastolic blood pressure; ICC, intraclass co
elation coefficient; LoA, limit of
agreement; LTR, liver transplant recipient; MCID, minimal clinically important difference; SBP, systolic blood pressure; STST, sit-to-stand
test.
Supported by the Princess Alexandra Hospital Research Support Scheme project grant. Shelley E. Keating is supported by the National
Health and Medical Research Council of Australia via an Early Career Research Fellowship (grant no XXXXXXXXXXIlaria Croci is supported by the
Swiss National Science Foundation with a Postdoctoral Fellowship.
Clinical Trial Registration No.: ACTRN XXXXXXXXXX.
Disclosures: none.
Presented as a poster to the 2018 Exercise and Sports Science Australia Research to Practice, March 27-29, 2018, Brisbane, Queensland,
Australia.
Cite this article as: Arch Rehabil Res Clin Transl. 2020;2:100066.
https:
doi.org/10.1016/j.a
ct XXXXXXXXXX
XXXXXXXXXX/ª 2020 The Authors. Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine. This is an open
access article under the CC BY-NC-ND license (http:
creativecommons.org/licenses
y-nc-nd/4.0/).
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crossmark.crossref.org/dialog/?doi=10.1016/j.a
ct XXXXXXXXXX&domain=pdf
https:
doi.org/10.1016/j.a
ct XXXXXXXXXX
http:
creativecommons.org/licenses
y-nc-nd/4.0
https:
doi.org/10.1016/j.a
ct XXXXXXXXXX
https:
www.sciencedirect.com/journal/archives-of-rehabilitation-research-and-clinical-translation
https:
doi.org/10.1016/j.a
ct XXXXXXXXXX
2 S.E. Keating et al.
KEYWORDS
Chronic disease;
Rehabilitation;
Self-assessment;
Technology;
Telemedicine
Abstract Objective: To compare agreement and reliability between clinician-measured and
patient self-measured clinical and functional assessments for use in remote monitoring, in a
home-based setting, using telehealth.
Design: Reliability study: repeated-measure, within-subject design.
Setting: Trained clinicians measured standard clinical and functional parameters at a face-to-
face clinic appointment. Participants were instructed on how to perform the measures at home
and to repeat self-assessments within 1 week.
Participants: Liver transplant recipients (LTRs) (NZ18) (52�14y, 56% men, 5.4�4.3y posttrans-
plant] completed the home self-assessments.
Interventions: Not applicable.
Main Outcome Measures: The outcomes assessed were body weight, systolic and diastolic
lood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST),
maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement
etween face-to-face clinician and self-reported home-based participant measures were
determined by intraclass-co
elation coefficients (ICCs) and Bland-Altman plots, which were
compared with minimal clinically important differences (MCID) (determined a priori).
Results: The mean difference (95% confidence interval) and [limits of agreement] for measures
(where positive values indicate lower participant value) were weight, XXXXXXXXXXkg [�2.2
to 3.6kg]; waist 0.4 (�1.2 to 2.0) cm [�5.9 to 6.8cm]; SBP XXXXXXXXXXmmHg [�19.4 to
34.9mmHg]; DBP 2.4 (�1.4 to 6.2 ) mmHg [�12.2 to 17.0mmHg]; 6MWT, 7.5 (�29.1 to
44.1) m [�127.3 to 142.4m]; STST 0.5 (�0.8 to 1.7) seconds [�4.3 to 5.3s]; maximal push-
ups �2.2 (�4.4 to �0.1) [�10.5 to 6.0]. ICCs were all >0.75 except for STST (ICCZ0.73). Mean
differences indicated good agreement than MCIDs; however, wide limits of agreement indi-
cated large individual variability in agreement.
Conclusions: Overall, LTRs can reliably self-assess clinical and functional measures at home.
However, there was wide individual variability in accuracy and agreement, with no functional
assessment being performed within acceptable limits relative to MCIDs >80% of the time.
ª 2020 The Authors. Published by Elsevier Inc. on behalf of the American Congress of Rehabil-
itation Medicine. This is an open access article under the CC BY-NC-ND license (http:
creativecommons.org/licenses
y-nc-nd/4.0/).
The use of telehealth strategies for chronic disease
management favors equitable access to health services fo
patients across wide geographical dispersion, increases
patient’s self-care management, and reduces the patient’s
time away from daily life as well as travel costs.1 Although a
variety of telehealth strategies have been used successfully
to deliver lifestyle interventions for weight reduction and
improvements in metabolic risk factors,2,3 their translation
into clinical practice is complex due to the need to monito
outcomes remotely.
Effectiveness of telehealth exercise interventions
often rely on monitoring change in functional tests such as
the 6-minute walk test (6MWT) and the repeated sit-to-
stand test (STST). These measures have shown good validity
and patient acceptability when conducted by health care
professionals.4,5 However, these clinical studies have
generally required participants to return to the clinical
center for repeat testing or outcome assessment and
therefore do not overcome the burden of face-to-face
attendance at the health care facility. Limited data are
available on the agreement and reliability of home-based
self-assessment of common clinical outcome measures
such as waist circumference6-8 and blood pressure.9-11
This study aimed to determine the level of agreement
and reliability of clinician-measured versus participant
self-measured (ie, in an unsupervised, home-based setting)
clinical and functional assessments commonly used fo
monitoring effectiveness of telehealth-delivered lifestyle
interventions in liver transplant recipients (LTRs). This pa-
tient cohort has previously indicated a preference and
motivation for flexible access to health care options
including telehealth monitoring.12 We hypothesized that
LTRs would reliably self-assess clinical and functional out-
comes with an acceptable level of agreement (ie, partici-
pant measures would be below a predetermined minimal
clinically important difference at least 80% of the time fo
each outcome measure).
Materials and methods
This is a substudy from a larger randomized controlled
feasibility study (35 participants randomized, with 27
participants completing the study) investigating telehealth-
to-home delivered lifestyle intervention to enhance
cardiometabolic health (ACTRN XXXXXXXXXXThe study
conformed to the ethical guidelines of the 1975 Declaration
of Helsinki and was approved by the Metro South Human
Research Ethics Committee (HREC/17/QPAH/208).
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Clinician vs patient assessment reliability 3
Participants were recruited from August to Decembe
2017. Participants were adults (aged XXXXXXXXXXunder the care
of the Queensland Liver Transplant Service, >6 months
posttransplant, expected survival>1 year, living within 100
km of the hospital (primary care center). Participants were
equired to have cu
ent access to a mobile phone o
computer hardware with internet access and capabilities
for webcam attachment. Volunteers were excluded if they
eported having a dietary restriction that would make the
dietary component of the parent study inappropriate, had a
physical disability that would impair participation in
physical activity, were deemed unsafe to participate in a
lifestyle intervention by a hepatologist or transplant
surgeon, or did not have sufficient English literacy. All
participants provided written informed consent prior to
participation.
Procedure
Trained health professionals (exercise physiologists [nZ2]
and dietitians [nZ4]) performed clinical and functional
assessments at a baseline face-to-face clinic appointment.
Baseline study appointments were attended for the purpose
of research and not due to clinical follow-up. Assessments
were performed by different health professionals from the
multidisciplinary research team to replicate a real-world
clinical setting. Participants were directed to undertake
self-measured clinical and functional assessments at home,
unsupervised, within 1 week of baseline clinic assessment.
The 1-week timeframe was designed to minimize the effect
of time on differences in repeat measures. Participants
were instructed on how to perform each assessment at
home and were provided with written instructions and links
to video-recorded tutorials to view online. Equipment fo
participants to conduct all functional measures and waist
circumference at home were provided (listed below).
Results were recorded and sent to investigators via email,
or ve
ally transcribed at the next telehealth appointment.
Participants received up to 3 phone call reminders to
complete the assessments. The clinician-measured face-to-
face assessments were compared with the patient-at-home
(unsupervised) assessments to determine agreement and
eliability.
Outcome measures were chosen to reflect the pragmatic
needs of real-world clinical telehealth practice where
eliable, accessible, inexpensive measures of metabolic risk
need to be longitudinally monitored to assess the effec-
tiveness of telehealth-delivered lifestyle interventions.
Clinical measures
Body mass
Clinician-assessed body weight was recorded to the nearest
0.5 kg (Robusta 813a). Participants used their own personal
scales to record weight (various
ands, not recorded).
Waist circumference
Clinician-assessed waist circumference was measured
midway between the lower rib margin and iliac crest with
stomach muscles relaxed, to the nearest 1 cm. Identical
tape measures were provided to all participants for the
epeat home measure with written and pictorial in-
structions to take the measure at the same site.
Blood pressure
Clinician-assessed systolic and diastolic blood pressure (SBP
and DBP) were performed seated using Welch Allyn Cerne
Vital Signs Monito
with an appropriate size