None listed
Conditions
Brief summary
BACKGROUND: The suitability of video conferencing (VC) technology for clinical purposes relevant to geriatric medicine is still being established. OBJECTIVES: This project aimed to identify the validity of the diagnosis of dementia via VC. DESIGN: This was a multi-site, non-inferiority, prospective cohort study. All patients were assessed independently by two specialist physicians. They were allocated one FTF assessment (Standard Clinical Practice) and an additional assessment (either standard FTF assessment or a VC assessment) on the same day. The order of assessment, both doctor and format, was randomized. Each physician had access to the patient chart and the results of a battery of standardised cognitive assessments administered FTF by the clinic nurse. SETTING: Four Memory Disorders Clinics. PATIENTS: Patients, aged 50 years and over, referred by their GP for cognitive assessment. MEASUREMENTS: Percentage agreement (P0) and the weighted kappa statistic with linear weight (Kw) were used to assess interrater reliability across the two study arms on the diagnosis of dementia (cognition normal, impaired or demented). RESULTS: Of 270 eligible patients, 210 underwent randomisation, with a final sample of 205 available for analysis: Videoconference Group (n=100) or Control Group (n=105). 106 were male. The average age was 76 (SD9, 51-95) and the average Standardised Mini-Mental State Examination Score was 23.9 (SD4.7, 9-30). Agreement for the Videoconference Group (PO= 0.71; kw = 0.52; p<0.0001) and agreement for the Control Group (PO= 0.70; kW = 0.50; p<0.0001) were both statistically significant (p<0.05). The summary kappa statistic of 0.51 (p=0.84) indicated that VC was not inferior to FTF assessment. LIMITATIONS: This study included a range of experienced and relatively newly qualified specialist physicians for the paired assessments. CONCLUSIONS: The diagnosis of dementia was reliable when assessed by VC.
Interventions
This project aimed to identify the validity of the diagnosis of dementia via Videoconference (VC).
All patients were assessed independently by two specialist physicians. They were allocated one face-to-face (FTF) assessment (Standard Clinical Practice) and an additional assessment (a VC assessment) on the same day. The order of assessment, both doctor and format, was randomized. Each physician had access to the patient chart and the results of a battery of standardised cognitive assessments
This project aimed to identify the validity of the diagnosis of dementia via Videoconference (VC). All patients were assessed independently by two specialist physicians. They were allocated one face-to-face (FTF) assessment (Standard Clinical Practice) and an additional assessment (a VC assessment) on the same day. The order of assessment, both doctor and format, was randomized. Each physician had access to the patient chart and the results of a battery of standardised cognitive assessments administered FTF by the clinic nurse. For VC assessment, the patient was shown to a clinic room by the nurse and introduced to the specialist physician via video. All paired assessments occurred on the same day. The protocol excluded any physical examination for both study arms, other than observation of gait and other evident physical features. Patients’ cognitive function was defined in accordance with the DSM-IV diagnosis of dementia (290.0-294.8), by the following three mutually exclusive options: ‘Normal cognitive function’ (No evidence of impairment meeting any of the criteria related to DSM-IV cognitive disorder); ‘Cognitive impairment no dementia’ (Evidence of impairment meeting some, but not all, DSM-IV criteria for dementia, including amnestic disorder and cognitive impairment not otherwise specified ); or ‘Dementia meeting DSM-IV criteria’ (all criteria meet). No specific time limit is stipulated for the assessments, but the assessment process is to be carried out during usual clinic days so in general the assessment (eithe face-to-face or via video conference), should be approimately 60 minutes. All assessments are to occur on the same day (with no minimum, maximum number of hours between assessments). If the second assessment can not be completed on the same day the patient is then excluded.
Sponsors
The University of Queensland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients referred by GP for assessment of cognition at a Memory Disorder Clinic. Patients over the age of 50.
Exclusion criteria
Patients previously seen by either specialist at the Memory Disorder Clinic. No consent.
Outcome results
None listed