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Evaluation of a Telerehabilitation Consultation Model for Remote Wheelchair Prescription

Schein, Richard Michael (2009) Evaluation of a Telerehabilitation Consultation Model for Remote Wheelchair Prescription. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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The purpose of this project was to determine the effectiveness of a telerehabilitation (TR) consultation model to prescribe and procure an appropriate wheeled mobility and seating (WMS) device at a remotely located site. The availability of practitioners with specific expertise in this area was limited particularly in Westerns Pennsylvania. A telerehabilitation service delivery model was developed for a series of studies based on a current model implemented at the Center for Assistive Technology at the University of Pittsburgh Medical Center (CAT-UPMC). In a multi-center non-randomized clinical trial, 96 participants were evaluated: 50 In-Person (IP) at the CAT-UPMC and 46 TR participants at remote sites. The performance-based Functioning Everyday with a Wheelchair-Capacity (FEW-C) tool demonstrated excellent inter-rater reliability coefficients (ICC 2,k = 0.91) and good internal consistency measured by Cronbach's alphas with correlations ranging between 0.82 to 0.91 among the 46 TR participants. Results indicated that using a TR consultation model, a significant improvement in mean differences was observed for the each of the self-report Functioning Everyday with a Wheelchair (FEW) items and for the average FEW scores at the remotely sites. Effect size calculations indicated that nine of the ten items on the FEW as well as the total FEW had very large effect sizes using Cohen's d, indicating the effectiveness of not only the new WMS device but the TR assessment as well. A significant relationship was found between the self-report FEW and performance-based FEW-C tools at baseline measured by Spearman rho's correlations. A significant difference was found for participants previous WMS device evaluation and prescription process compared to their current TR WMS device evaluation and prescription scores as well as patient satisfaction regarding the impact of the technology. The findings based on confidence intervals of post FEW scores indicated that TR was non-inferior to the standard IP care at CAT-UPMC. Telerehabilitation services resulted in decreased travel for participants, improved access to specialized services, education benefits for generalist practitioners, and service stabilization at the remote sites. A TR consultation model offers new alternative and effective opportunities to provide rehabilitation services in clinical settings, especially in rural or underserved locations.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Schein, Richard Michaelrms35@pitt.eduRMS35
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrienza, Daviddbrienza@pitt.eduDBRIENZA
Committee MemberBetz,
Committee MemberHolm, Margombholm@pitt.eduMBHOLM
Committee MemberSchmeler, Markschmeler@pitt.eduSCHMELER
Committee MemberGeyer, Mary
Committee MemberPramuka, Michaelmpramuka@pitt.eduMPRAMUKA
Date: 5 June 2009
Date Type: Completion
Defense Date: 20 March 2009
Approval Date: 5 June 2009
Submission Date: 17 April 2009
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: assistive technology; telerehabilitation; service delivery; wheelchair prescription
Other ID:, etd-04172009-090925
Date Deposited: 10 Nov 2011 19:38
Last Modified: 15 Nov 2016 13:40


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