Journal of Telemedicine and Telecare > Volume 15, Number 4 > Pp. 196-202

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RESEARCH Original articles

Validation of home telehealth for pressure ulcer assessment: a study in patients with spinal cord injury

Michelle L Hill ^*, Ruth C Cronkite    , Doug T Ota ^*, Elisa C Yao ^** and B Jenny Kiratli ^*

^* Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, California; Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, California; Center for Primary Care and Outcomes Research, Stanford University, California; Department of Sociology, Stanford University, California; ^** Department of Physical Medicine and Rehabilitation, University of California Davis, California, USA

Correspondence: Dr Ruth C Cronkite, Center for Health Care Evaluation (152MPD), Veterans Affairs Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA (Fax: +1 650 617 2736; Email: ruth.cronkite{at}va.gov)

The reliability and validity of assessments and diagnoses made via home telehealth was measured in 42 patients with spinal cord injury. Two telehealth modalities were investigated: telephone-only contact and videoconferencing. The results were compared with a reference (gold-standard) method, the in-person assessment and diagnosis of skin integrity and pressure ulcers. The agreement on the presence of a pressure ulcer was excellent for both telephone and videoconferencing approaches (92% for telephone, 97% for videoconferencing). The diagnoses of the stage of pressure ulcer (on an ordinal scale of 0–4) made via telephone and videoconferencing showed substantial to almost perfect agreement with the in-person diagnoses (Spearman's rho of 0.76 and 0.83, respectively). There was a tendency for the measurements of wound volume to be somewhat larger in the telephone and videoconferencing modalities compared to those made in-person. Bland-Altman plots showed that videoconferencing gave substantially narrower 95% limits of agreement. The findings of the study indicate that telephone contact can be a useful tool for identifying the presence of a pressure ulcer, but videoconferencing is required to obtain an evaluation reasonably close to that of a home visit.

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