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J.R. Tan1, S. Coulson1, M. Keep2
1The University of Sydney, Faculty of Medicine and Health, Discipline of Physiotherapy, Sydney, Australia, 2The University of Sydney, Faculty of Medicine and Health, Sydney, Australia
Background: Patients with facial nerve paralysis (FNP) face challenges to healthcare access that could potentially be overcome by telemedicine. Telemedicine has become an increasingly common assessment and treatment method since the onset of COVID-19, however the reliability of telemedicine has yet to be established in this area.
Purpose: Reliable and effective management of FNP requires initial and ongoing assessment of patients’ facial function. This study aimed to investigate the consistency between face-to-face and video simulated telemedicine-assessment of patients with FNP by experienced clinicians.
Methods: A repeated-measures design was used. Seven clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardised grading systems (the House-Brackmann, Sydney, and Sunnybrook Facial Grading Systems). Three months later, the same grading systems were used to assess facial palsy in video recordings of the same patients. Reliability and close agreement were determined with intraclass correlation coefficients (ICC) and percentage close agreement (PCA).
Results: Among the 28 participants (mean [SD] age, 41.7[15.4] years, 12 males and 16 females), the House-Brackmann system in video assessment had excellent reliability and agreement (ICC=0.780; PCA=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0% to 95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), while that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7% to 100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3% to 100.0%) and synkinesis (ICC=-0.037 to 0.637; PCA=69.6% to 87.0%), but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5% to 91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within +/-1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system.
Conclusion(s): Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions which occur during tele-assessment sessions.
Implications: The results of this study support the use of telemedicine as a reliable and effective method of managing facial nerve paralysis. Future studies may investigate the video-assessment of synkinesis with the aim of increasing reliability in this area. Furthermore, an increased understanding of the impacts of real-time interactions in the clinical management of facial nerve paralysis may inform both telemedicine and face to face healthcare practice.
Funding, acknowledgements: This study did not receive funding
Keywords: Facial Nerve Paralysis, Telemedicine, Covid-19
Topic: COVID-19
Did this work require ethics approval? Yes
Institution: The University of Sydney
Committee: Human Ethics
Ethics number: X17-0013 & HREC/17/RPAH/10
All authors, affiliations and abstracts have been published as submitted.
