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Unit 6 Assignment 2: Statistics Applied to Research Studies Analyze these 3 correlational, case, and cross-sectional research studies. Based on your findings, explain why these statistics are used. Total 1-2-page summary explaining these statistics in general words. Correlational study Keating, S. E., Barnett, A., Croci, I., Hannigan, A., Elvin-Walsh, L., Coombes, J. S., ... & Hickman, I. J. (2020). Agreement and reliability of clinician-in-clinic vs patient-at-home clinical and functional assessments: implications for telehealth services. Archives of Rehabilitation Research and Clinical Translation, 100066. https://doi.org/10.1016/j.arrct.2020.100066 Case-control study Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence. https://doi.org/10.21203/rs.3.rs-23906/v3 Cross-sectional study Ghaddar, S., Vatcheva, K. P., Alvarado, S. G., & Mykyta, L. (2020). Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study. Journal of Medical Internet Research, 22(9), e21012. https://doi:10.2196/21012 Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services Archives of Rehabilitation Research and Clinical Translation (2020) 2, 100066 Archives of Rehabilitation Research and Clinical Translation Archives of Rehabilitation Research and Clinical Translation 2020;2:100066 Available online at www.sciencedirect.com Original Research Agreement and Reliability of Clinician-in- Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services Shelley E. Keating, PhD a, Amandine Barnett, M Nut & Diet Practice b,c, Ilaria Croci, PhD a,d, Amy Hannigan, BHSci (Nut & Diet) c, Louise Elvin-Walsh, BHSci (Nut & Diet) c, Jeff S. Coombes, PhD a, Katrina L. Campbell, PhD b,c, Graeme A. Macdonald, PhD, MBBS e,f,g, Ingrid J. Hickman, PhD c,h a School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia b Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia c Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia d K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway e Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia f Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia g School of Medicine, The University of Queensland, Brisbane, Queensland, Australia h Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia List of abbreviations: 6MWT, 6-minute walk test; DBP, diastolic blood pressure; ICC, intraclass correlation coefficient; LoA, limit of agreement; LTR, liver transplant recipient; MCID, minimal clinically important difference; SBP, systolic blood pressure; STST, sit-to-stand test. Supported by the Princess Alexandra Hospital Research Support Scheme project grant. Shelley E. Keating is supported by the National Health and Medical Research Council of Australia via an Early Career Research Fellowship (grant no. 122190). Ilaria Croci is supported by the Swiss National Science Foundation with a Postdoctoral Fellowship. Clinical Trial Registration No.: ACTRN12617001260314. Disclosures: none. Presented as a poster to the 2018 Exercise and Sports Science Australia Research to Practice, March 27-29, 2018, Brisbane, Queensland, Australia. Cite this article as: Arch Rehabil Res Clin Transl. 2020;2:100066. https://doi.org/10.1016/j.arrct.2020.100066 2590-1095/ª 2020 The Authors. Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://crossmark.crossref.org/dialog/?doi=10.1016/j.arrct.2020.100066&domain=pdf https://doi.org/10.1016/j.arrct.2020.100066 http://creativecommons.org/licenses/by-nc-nd/4.0/ https://doi.org/10.1016/j.arrct.2020.100066 https://www.sciencedirect.com/journal/archives-of-rehabilitation-research-and-clinical-translation https://doi.org/10.1016/j.arrct.2020.100066 2 S.E. Keating et al. KEYWORDS Chronic disease; Rehabilitation; Self-assessment; Technology; Telemedicine Abstract Objective: To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. Design: Reliability study: repeated-measure, within-subject design. Setting: Trained clinicians measured standard clinical and functional parameters at a face-to- face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. Participants: Liver transplant recipients (LTRs) (NZ18) (52�14y, 56% men, 5.4�4.3y posttrans- plant] completed the home self-assessments. Interventions: Not applicable. Main Outcome Measures: The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). Results: The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [�2.2 to 3.6kg]; waist 0.4 (�1.2 to 2.0) cm [�5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [�19.4 to 34.9mmHg]; DBP 2.4 (�1.4 to 6.2 ) mmHg [�12.2 to 17.0mmHg]; 6MWT, 7.5 (�29.1 to 44.1) m [�127.3 to 142.4m]; STST 0.5 (�0.8 to 1.7) seconds [�4.3 to 5.3s]; maximal push- ups �2.2 (�4.4 to �0.1) [�10.5 to 6.0]. ICCs were all >0.75 except for STST (ICCZ0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indi- cated large individual variability in agreement. Conclusions: Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time. ª 2020 The Authors. Published by Elsevier Inc. on behalf of the American Congress of Rehabil- itation Medicine. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). The use of telehealth strategies for chronic disease management favors equitable access to health services for patients across wide geographical dispersion, increases patient’s self-care management, and reduces the patient’s time away from daily life as well as travel costs.1 Although a variety of telehealth strategies have been used successfully to deliver lifestyle interventions for weight reduction and improvements in metabolic risk factors,2,3 their translation into clinical practice is complex due to the need to monitor outcomes remotely. Effectiveness of telehealth exercise interventions often rely on monitoring change in functional tests such as the 6-minute walk test (6MWT) and the repeated sit-to- stand test (STST). These measures have shown good validity and patient acceptability when conducted by health care professionals.4,5 However, these clinical studies have generally required participants to return to the clinical center for repeat testing or outcome assessment and therefore do not overcome the burden of face-to-face attendance at the health care facility. Limited data are available on the agreement and reliability of home-based self-assessment of common clinical outcome measures such as waist circumference6-8 and blood pressure.9-11 This study aimed to determine the level of agreement and reliability of clinician-measured versus participant self-measured (ie, in an unsupervised, home-based setting) clinical and functional assessments commonly used for monitoring effectiveness of telehealth-delivered lifestyle interventions in liver transplant recipients (LTRs). This pa- tient cohort has previously indicated a preference and motivation for flexible access to health care options including telehealth monitoring.12 We hypothesized that LTRs would reliably self-assess clinical and functional out- comes with an acceptable level of agreement (ie, partici- pant measures would be below a predetermined minimal clinically important difference at least 80% of the time for each outcome measure). Materials and methods This is a substudy from a larger randomized controlled feasibility study (35 participants randomized, with 27 participants completing the study) investigating telehealth- to-home delivered lifestyle intervention to enhance cardiometabolic health (ACTRN12617001260314). The study conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Metro South Human Research Ethics Committee (HREC/17/QPAH/208). http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ Clinician vs patient assessment reliability 3 Participants were recruited from August to December 2017. Participants were adults (aged 18-70) under the care of the Queensland Liver Transplant Service, >6 months posttransplant, expected survival>1 year, living within 100 km of the hospital (primary care center). Participants were required to have current access to a mobile phone or computer hardware with internet access and capabilities for webcam attachment. Volunteers were excluded if they reported having a dietary restriction that would make the dietary component of the parent study inappropriate, had a physical disability that would impair participation in physical activity, were deemed unsafe to participate in a lifestyle intervention by a hepatologist or transplant surgeon, or did not have sufficient English literacy. All participants provided written informed consent prior to participation. Procedure Trained health professionals (exercise physiologists [nZ2] and dietitians [nZ4]) performed clinical and functional assessments at a baseline face-to-face clinic appointment. Baseline study appointments were attended for the purpose of research and not due to clinical follow-up. Assessments were performed by different health professionals from the multidisciplinary research team to replicate a real-world clinical setting. Participants were directed to undertake self-measured clinical and functional assessments at home, unsupervised, within 1 week of baseline clinic assessment. The 1-week timeframe was designed to minimize the effect of time on differences in repeat measures. Participants were instructed on how to perform each assessment at home and were provided with written instructions and links to video-recorded tutorials to view online. Equipment for participants to conduct all functional measures and waist circumference at home were provided (listed below). Results were recorded and sent to investigators via email, or verbally transcribed at the next telehealth appointment. Participants received up to 3 phone call reminders to complete the assessments. The clinician-measured face-to- face assessments were compared with the patient-at-home (unsupervised) assessments to determine agreement and reliability. Outcome measures were chosen to reflect the pragmatic needs of real-world clinical telehealth practice where reliable, accessible, inexpensive measures of metabolic risk need to be longitudinally monitored to assess the effec- tiveness of telehealth-delivered lifestyle interventions. Clinical measures Body mass Clinician-assessed body weight was recorded to the nearest 0.5 kg (Robusta 813a). Participants used their own personal scales to record weight (various brands, not recorded). Waist circumference Clinician-assessed waist circumference was measured midway between the lower rib margin and iliac crest with stomach muscles relaxed, to the nearest 1 cm. Identical tape measures were provided to all participants for the repeat home measure with written and pictorial in- structions to take the measure at the same site. Blood pressure Clinician-assessed systolic and diastolic blood pressure (SBP and DBP) were performed seated using Welch Allyn Cerner Vital Signs Monitorb with an appropriate size