{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:31:01Z","timestamp":1777534261450,"version":"3.51.4"},"reference-count":10,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,10,11]],"date-time":"2020-10-11T00:00:00Z","timestamp":1602374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005616","name":"Allergan Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005616","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Rehabil"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the performance of telehealth as a screening tool for spasticity compared to direct patient assessment in the long-term care setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Cross-sectional, observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Two long-term care facilities: a 140-bed veterans\u2019 home and a 44-bed state home for individuals with intellectual and developmental disabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects:<\/jats:title>\n                    <jats:p>Sixty-one adult residents of two long-term care facilities (aged 70.1\u2009\u00b1\u200916.2\u2009years) were included in this analysis. Spasticity was identified in 43% of subjects (Modified Ashworth Scale rating mode\u2009=\u20092). Contributing diagnoses included traumatic brain injury, spinal cord injury, birth trauma, stroke, cerebral palsy, and multiple sclerosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main measures:<\/jats:title>\n                    <jats:p>Movement disorders neurologists conducted in-person examinations to determine whether spasticity was present (reference standard) and also evaluated subjects with spasticity using the Modified Ashworth Scale. Telehealth screening examinations, facilitated by a bedside nurse, were conducted remotely by two teleneurologists using a three-question screening tool. Telehealth screening determinations of spasticity were compared to the reference standard determination to calculate sensitivity, specificity, and the area under the curve (AUC) in receiver operating characteristics. Teleneurologist agreement was evaluated using Cohen\u2019s kappa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Teleneurologist 1 had a specificity of 89% and sensitivity of 65% to identify the likely presence of spasticity ( n\u2009=\u200961; AUC\u2009=\u20090.770). Teleneurologist 2 showed 100% specificity and 82% sensitivity ( n\u2009=\u200916; AUC\u2009=\u20090.909). There was almost perfect agreement between the two examiners at 94% (kappa\u2009=\u20090.875, 95% CI: 0.640\u20131.000).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Telehealth may provide a useful, efficient method of identifying residents of long-term care facilities that likely need referral for spasticity evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0269215520963845","type":"journal-article","created":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T04:47:35Z","timestamp":1602478055000},"page":"589-594","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4504-6232","authenticated-orcid":false,"given":"Kelly A","family":"Harper","sequence":"first","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9581-5549","authenticated-orcid":false,"given":"Emily C","family":"Butler","sequence":"additional","affiliation":[{"name":"Vanderbilt University, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory L","family":"Hacker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"},{"name":"Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2662-4025","authenticated-orcid":false,"given":"Aaditi","family":"Naik","sequence":"additional","affiliation":[{"name":"The University of Chicago Pritzker School of Medicine, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan R","family":"Eoff","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fenna T","family":"Phibbs","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A","family":"Isaacs","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J","family":"Gallion","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esmeralda P","family":"Thomas","sequence":"additional","affiliation":[{"name":"Tennesse Department of Intellectual and Developmental Disabilities, Middle Tennessee Homes, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim L","family":"Scott","sequence":"additional","affiliation":[{"name":"Tennesse Department of Intellectual and Developmental Disabilities, Middle Tennessee Homes, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby","family":"Ploucher","sequence":"additional","affiliation":[{"name":"Florida State University College of Medicine, Tallahassee, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline C","family":"Meystedt","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan E","family":"McLeod","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip David","family":"Charles","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,10,11]]},"reference":[{"key":"bibr1-0269215520963845","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.05.015"},{"issue":"5","key":"bibr2-0269215520963845","first-page":"2","volume":"3","author":"Turchan 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