Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.
College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia.
J Acad Nutr Diet. 2023 Aug;123(8):1207-1214.e3. doi: 10.1016/j.jand.2023.04.005. Epub 2023 Apr 14.
Teleconsultation via videocall by a dietitian may allow remote diagnosis of malnutrition amongst patients undertaking home rehabilitation; however, whether or not a physical examination can be performed accurately remotely has not yet been determined.
This study aimed to compare agreement between an in-person and videocall by a dietitian for overall physical assessment in patients admitted to a home rehabilitation service.
This was a cross-sectional diagnostic accuracy study.
This study involved 71 adults admitted to the home rehabilitation program at Flinders Medical Centre in Adelaide, South Australia, Australia, between September 2019 to November 2019 and August 2020 to November 2020.
Validity of the videocall by a dietitian to undertake a physical assessment was determined using an in-person physical assessment completed by a trained dietitian in the participant's own home. A dietitian blinded to the in-person assessment completed the physical examination via a videocall to determine the presence and degree of deficit at each anatomical site and make an overall physical assessment.
Percentage agreement, weighted kappa, sensitivity, and specificity were determined to assess agreement between videocall and in-person assessments undertaken by a dietitian.
The overall videocall physical examination by a dietitian rating achieved a percentage agreement of 69.0% against the in-person assessment by a dietitian, with a weighted kappa agreement of 0.658 (95% CI 0.530 to 0.786), sensitivity of 87.5%, and specificity of 81.1%.
The substantial weighted kappa, good sensitivity, and specificity supports the use of the physical assessment in contributing to diagnosing malnutrition via videocall in home rehabilitation settings. Services that are without a local dietetic workforce should consider using dietitians to undertake videocalls for the physical examination component of nutrition assessment to facilitate timely nutrition assessment and optimal nutrition interventions, as well as support review of nutrition interventions.
通过视频电话由营养师进行远程会诊，可能可以对正在接受家庭康复的患者进行营养不良的远程诊断；但是，远程是否可以准确进行体格检查尚未确定。
本研究旨在比较在接受家庭康复服务的患者中，营养师进行面对面和视频电话检查的整体身体评估之间的一致性。
这是一项横断面诊断准确性研究。
本研究纳入了 2019 年 9 月至 2019 年 11 月和 2020 年 8 月至 2020 年 11 月期间在澳大利亚南澳大利亚阿德莱德弗林德斯医疗中心家庭康复计划中入院的 71 名成年人。
通过由受过培训的营养师在参与者的家中进行的面对面身体评估来确定营养师进行视频电话进行身体评估的有效性。一位营养师对面对面评估不知情，通过视频电话进行身体检查，以确定每个解剖部位的存在和缺陷程度，并进行整体身体评估。
使用百分比一致性、加权 κ、敏感性和特异性来评估营养师进行的视频电话和面对面评估之间的一致性。
营养师的总体视频电话体格检查与营养师的面对面评估相比，达到了 69.0%的百分比一致性，加权 κ 一致性为 0.658（95%CI 0.530 至 0.786），敏感性为 87.5%，特异性为 81.1%。
大量的加权 κ、良好的敏感性和特异性支持在家庭康复环境中通过视频电话进行营养评估时使用体格检查来诊断营养不良。没有当地营养师队伍的服务机构应考虑使用营养师进行视频电话检查，以进行营养评估的体格检查部分，以促进及时进行营养评估和最佳营养干预，并支持营养干预的审查。
