A Study On Agreement And Validity For The Outcomes Of Stroke Patients Interviewed By Telephone And Face-to-face Assessment

Background:Stroke is one of the third death causes of mankind.The international medical community more and more put emphasis on the study of the evaluation of stroke outcome and to serve as an important indicator of clinical efficacy.The telephone interview was the main form of outcome assessment in stroke patients, but the validity of telephone interview was rarely reported recently in China. It would be a great important practical significance that studies on the reliability and validity of outcome assessment by telephone interview in stroke patients with different syndromes of traditional Chinese medicine (TCM).Objective:To evaulate the agreement between telephone interviews and face-to-face assesment in the stroke patients discharged from hospital;to assess the validity of telephone interview and patient reported outcome;to analysize the reasons of inconsistencies of telephone interviews assessment in stroke patients with different syndromes of TCM.Methods:By means of telephone interview survey methods and comparing with physicians face-to-face review,50 cases of stroke patients who meet the selection criteria were selected from the Guangdong Provincial Hospital of Traditional Chinese Medicine(TCM)Stroke Registry Database.The patients would be accepted the assessment by telephone interview and physician's face-to-face review,and the Barthel Index(BI)and modified Rankin scles(MRS)were collected from these two interviews independently.The Kappa test,intraclass correlation coefficient(ICC)and diagnostic test were performed to analysize the validity and reliability of telephone interview.Results: Of 50 cases of stroke patients were included in the study,and patients' BI and MRS were evaluated by telephone interview and physicians' face-to-face review independently.The average kappa value of all items of BI was great than 0.7,ICC of total scores of BI was great than 0.75.The result showed that good consistency and validity of telephone interview in stroke patients. The telephone interview compared with physicians' face-to-face review which was as gold standard,the diagnostic test and receiver operator characteristic curve(ROC)was used to analysize the validity of telephone interview.The area under the ROC is 99.3%,and it indicated that there was high accuracy assessing by telephone interview.The sensitivity and specificity of 90%of BI items in both proxies and stroke patients were great than 0.80,and it indicated that a good validity for telephone interview.When telephone interview were carried through patients' own self,the sensitivity and specificity of some items of BI were fluctuations in value,or even were impossible to calculate.The results might related with lower representativeness of stroke patients in this study,becauses this results presented to the same assessment between telephone interview and physician's face-to-face review accounted for large ratio.The item urinate of BI was very low kappa,and it was not accord with real status of assessment.It might seem to be a limitation of kappa test.Conclusion:The results suggest that the outcome of stroke patients assessed by telephone interviews were good validity comparing with physicians' face-to-face review. The telephone interview may be an alternative way for physicians' face-to-face assessment.The results were similar to other studies in the world. It also found that there was no effect on the results in the different syndromes of TCM by analysis.This study will provide evidences for the follow-up of long-term prognosis in stroke patients by telephone interview.Meanwhile,the study has some disadvantage yet,a study of representativeness sample seem to be needed.