Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services.
Shelley E Keating, Amandine Barnett, Ilaria Croci and 6 others
PMID 33543092WHAT IT FOUND
Patients measuring their own health data at home matched clinicians on average, but individual results varied too widely to be trusted.
Only body weight was accurate enough for clinical decisions. Waist size, blood pressure, and fitness tests failed safety checks for remote monitoring.
Key findings
01Body weight was the only measure where patients' home results fell within clinically acceptable limits for at least 80% of participants.
02For all other clinical and functional measures, the range of difference between patient and clinician scores was too wide to be clinically acceptable, despite good average agreement.
03Only half of the eligible patients completed the home assessments, and those who did took an average of 12.6 days, exceeding the one-week target.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only 18 participants who completed home measures, making it difficult to generalize the findings. Only 51% of eligible patients completed the home assessments, and those who did not were more likely to be men and had slower chair-stand times, suggesting the results may not represent the broader patient population. The average time between clinic and home testing was 12.6 days, exceeding the one-week target, which may have introduced additional variability. The study relied on minimal clinically important differences derived from other populations, as specific data for liver transplant recipients was lacking. Blood pressure measurements were not standardized for time of day or white-coat effects, which could influence agreement.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that because average scores matched between patients and clinicians, home measurements are safe for individual care decisions. The study found that for most measures, individual errors were large enough to change clinical judgment, and only weight was reliable enough for unsupervised use.