Evaluating Remote and In-Person Physical Function Assessments in Chronic Kidney Disease Patients
Chronic kidney disease (CKD) increases the risk of poor physical function, which affects transplant suitability and self-management. Routine functional assessments are underutilized in CKD care and validating remote and patient-reported outcome measures (PROMs) could improve access and implementation. The primary objectives are as follows: determine if there is a difference between in-person assessors (INPA) and remote assessors (RA) for physical function performance tests, determine if there is difference between hand grip strength (HGS) scores between the Jamar dynamometer (the gold standard) and a digital dynamometer, and evaluate the association between PROMIS 20a and physical function performance tests. Participants completed self-report surveys and physical function tests in two clinic visits 2-4 weeks apart. Physical function was assessed using hand grip strength with digital and Jamar dynamometers, timed-up and go (TUG), and 6-meter gait speed tests. Validity was evaluated using Bland-Altman plots with 95% limits of agreement (LOA) for device and remote/in-person comparison and Pearson correlations for PROMIS 20a. Out of 61 screened, 16 participants enrolled and completed 2 visits. The study population was 47% female, 53% male, 71% Black, 29% White, and 56% college graduates. Remote assessments showed consistent overestimation in Visit 1 and Visit 2 for TUG and gait speed tests compared to in-person assessments. The digital device consistently provided lower hand grip strength measurements than the Jamar device for both Visit 1 and Visit 2. Moderate to strong negative correlations were observed between PROMIS 20a t-scores and gait speed. There is excellent agreement of remote and in-person measures of TUG times. The digital dynamometer was found to consistently produce lower values than Jamar. Findings suggest that PROMIS 20a is closely correlated with gait speed, an objective physical function test. Future studies could include the exploration of a correction factor for usage of the digital dynamometer and evaluating how well PROMIS 20a t-scores predict clinical outcomes compared to objective measures (i.e. gait speed).
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