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Use of a Telerehabilitation Delivery System for Fall Risk Screening Robert W

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Nova Southeastern University NSUWorks Department of Physical Therapy Student Theses, Department of Physical Therapy Dissertations and Capstones 1-1-2018 Use of a Telerehabilitation Delivery System for Fall Risk Screening Robert W. Nithman Nova Southeastern University This document is a product of extensive research conducted at the Nova Southeastern University College of Health Care Sciences. For more information on research and degree programs at the NSU College of Health Care Sciences, please click here. Follow this and additional works at: https://nsuworks.nova.edu/hpd_pt_stuetd Part of the Physical Therapy Commons All rights reserved. This publication is intended for use solely by faculty, students, and staff of oN va Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher. NSUWorks Citation Robert W. Nithman. 2018. Use of a Telerehabilitation Delivery System for Fall Risk Screening. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences - Physical Therapy Department. (77) https://nsuworks.nova.edu/hpd_pt_stuetd/77. This Dissertation is brought to you by the Department of Physical Therapy at NSUWorks. It has been accepted for inclusion in Department of Physical Therapy Student Theses, Dissertations and Capstones by an authorized administrator of NSUWorks. For more information, please contact [email protected]. The Use of a Telerehabilitation Delivery System for Fall Risk Screening By: Robert W. Nithman, PT, DPT, MPT, GCS A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Nova Southeastern University College of Health Sciences Department of Physical Therapy 2018 Signature Page We hereby certify that this dissertation, submitted by Robert W. Nithman conforms to acceptable standards and is fully adequate in scope and quality to fulfill the dissertation requirement for the degree of Doctor of Philosophy. _______________________________________________ _____________________ Dr. Cheryl J. Hill, PT, DPT, PhD Date Chairperson of Dissertation Committee _______________________________________________ _____________________ Dr. M. Samuel Cheng, PT, MS, Sc.D Date Dissertation Committee Member _______________________________________________ _____________________ Dr. Alan Chong W. Lee, PT, PhD, DPT, GCS, WCS Date Dissertation Committee Member Approved: _______________________________________________ ___________________ Dr. M. Samuel Cheng, PT, MS, Sc.D Date Associate Professor Director, PhD in Physical Therapy Program _______________________________________________ ___________________ Dr. Shari Rone-Adams, PT, MHSA, DBA Date Associate Professor Chair, Department of Physical Therapy _______________________________________________ ___________________ Dr. Stanley Wilson, PT, Ed.D, CEAS Date Dean, Dr. Pallavi Patel College of Health Care Sciences Abstract Problem: The Centers for Disease Control and Prevention indicates that falls are the “leading cause of injury death and the most common cause of nonfatal injuries and hospital admission for trauma among people ages 65 and older.”1 Falls can have significant economic consequences to the individual and payer sources. To address these consequences, telerehabilitation was hypothesized to be a suitable supplement for fall screening efforts. Several sources concluded that support for synchronous telerehab was underdeveloped in the literature. Purpose: The purpose of this study was to explore the acceptability, feasibility, reliability, and validity of telehealth-delivered fall screening among community-dwelling older adults. Procedures: This investigation implemented an experimental, quantitative, cross-sectional design employing both pretest-posttest control group and quasi-experimental static group comparisons using non- probability sampling. This study assembled a panel of experts to provide content validation for a survey tool developed to quantify an older adult’s behavioral intension to use and attitudes towards a telerehabilitation delivery system. Seven fall screening tools were investigated for agreement among remote and face-to-face raters, and for comparison with the face-to-face reference standard (Mini-BEST). Results: All three null hypotheses were rejected. Results indicate that a telerehabilitation delivery system is a reliable and valid method of screening and determining fall risk in community-dwelling older adults. This study produced a content validated, internally consistent survey instrument designed to determine attitudes and beliefs about telerehabilitation. An experimental design was able to demonstrate a positive significant change in 4 of 7 survey constructs among the intervention group after exposure to telerehabilitation as compared to post-test controls. Overall, no significant difference was calculated between face-to-face or telerehab raters, and both environments produced equivalency with scoring, fall risk classification, and ability to discern fallers from non-fallers. Results from the telerehab STEADI fall risk conclusions were calculated to be concurrently valid with the face-to-face reference standard screening tool, the Mini-BEST. Conclusions: This investigation expanded the array of remote healthcare delivery options for clinicians and clients. Further investigation in residential and community settings are recommended. Keywords: Telerehabilitation, Elderly falls, Telehealth, Technology acceptance Acknowledgements First, I would like to thank my dissertation Chair, Dr. Cheryl Hill, for her understanding, patience, and excellent guidance through the stages and challenges of the dissertation process. To the members of my doctoral committee, Dr. Mingshun Cheng and Dr. Alan Lee, my sincerest thanks and appreciation for your input and support during this challenging journey. I would also like to thank my colleagues, mentors, and friends for sharing their wisdom, enthusiasm, and willingness to listen to my ideas, experiences, and challenges. I am grateful for my study participants, student volunteers, as well as members of my panel of experts for sharing their time and interest in my research. I would like to acknowledge my wife and three children. Your love and support saw me through this trying time and helped me see the triumph that we can all share when we set goals, stick together, and persevere through adversity. Your smiles and hugs have carried me through many long nights in front of my computer. To my mother and father, both of whom gave this orphan a new start on life at a young age, I know you too will be sharing in the joy of this accomplishment from heaven above. Earning this fourth college degree is a testament to your encouragement to be the first college graduate in our family. Thank you for allowing me to dream and for always implicitly saying, “Yes you can.” Lastly, I want to thank my Lord and Savior, Jesus Christ, for guiding me through this journey and for seeing my potential as an educator and researcher. I look forward to seeing what you have planned for me next! Table of Contents List of Tables .................................................................................................................................. x List of Figures .............................................................................................................................. xiii CHAPTER ONE: INTRODUCTION Introduction ......................................................................................................................... 1 Problem Statement and Purpose ......................................................................................... 2 Relevance and Significance ................................................................................................ 3 Practical Application of the Findings ................................................................................. 9 Barriers and Issues ............................................................................................................ 12 Research Questions / Hypotheses ..................................................................................... 16 Operational Definition of Terms ....................................................................................... 17 Summary ........................................................................................................................... 19 CHAPTER TWO: LITERATURE REVIEW Introduction ....................................................................................................................... 20 Historical Overview of the Theory and Research Literature ............................................ 21 The Theory and Research Literature Specific to the Topic .............................................. 24 Literature Related to Technology Acceptance Theories…………………………24 Literature Related to Elderly Falls……………………………………………….41 Balance Evaluation System’s Test (BESTest) .................................................................. 45 Berg Balance Scale (BBS) ................................................................................................ 47 Clinical Test of Sensory Interaction and Balance (CTSIB) .............................................. 49 Dynamic Gait Index (DGI) ..............................................................................................
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