远程医疗服务的提供越来越多,包括营养服务。然而,由于难以远程进行物理评估,远程营养评估具有挑战性,评估营养状况的重要组成部分。
这项研究的目的是评估使用由专职健康助理(AHA)捕获的静态图像远程完成患者生成的主观全局评估体格检查是否可以替代入院的患者进行现场体格检查。家庭康复服务。
这项研究在设计上是横断面的。
这项研究涉及104名在南阿德莱德当地健康网络接受家庭康复服务的成年人,阿德莱德,澳大利亚,2019年和2020年超过2个采样期,他们正在接受AHA的家访并从事康复活动。
基于静止图像的身体评估的有效性是使用由AHA收集的静止图像和由营养师从每个参与者完成的亲自身体评估来确定的。对当面结果不了解的营养师随后评估了去识别的静止图像,以确定在每个解剖部位处的缺陷的存在和程度以及患者生成的主观全局评估的总体体检部分。
百分比协议,加权κ,灵敏度,并确定了基于静态图像的体检和现场体检之间的特异性,以评估两种评估方法之间的一致性。
基于静止图像的体格检查与现场检查达成了75%的百分比一致性,加权κ为0.662(95%置信区间0.516-0.808),敏感性-特异性对为76.6%和89.1%。
使用AHA收集的静止图像进行的身体检查达到了百分比一致,κ,与与通常采用的营养筛查和评估工具一致或优于通常采用的身体检查相比,敏感性和特异性。有可能实施这种方法来促进营养师的远程营养评估;但是,需要进一步的工作来确保营养师能够可靠地评估静态图像。
There is increasing provision of telehealth services, including nutrition services. However, remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status.
The aim of this study was to evaluate whether remote completion of the Patient-Generated Subjective Global Assessment physical examination using still images captured by allied health assistants (AHAs) is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service.
This study was cross-sectional in design.
This study involved 104 adults admitted to the home rehabilitation service at Southern Adelaide Local Health Network, Adelaide, Australia, over 2 sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities.
Validity of the still image-based physical assessment was determined using still images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-Generated Subjective Global Assessment.
Percentage agreement, weighted κ, sensitivity, and specificity between the still image based and in-person physical examinations were determined to assess agreement between the 2 methods of assessment.
The still image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted κ of 0.662 (95% confidence interval 0.516-0.808) and a sensitivity-specificity pair of 76.6% and 89.1%.
Physical examination using still images collected by AHAs achieved percentage agreement, κ, and sensitivity and specificity compared with an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians; however, further work is needed to ensure dietitians are able to assess still images reliably.