Validation of remote anthropometric measurements in a rural randomized pediatric clinical trial in primary care settings

Abstract

Background: Rural children are more at risk for childhood obesity but may have difficulty participating in pediatric weight management clinical trials if in-person visits are required. Remote assessment of height and weight observed via videoconferencing may provide a solution by improving the accuracy of self-reported data. This study aims to validate a low-cost, scalable video-assisted protocol for remote height and weight measurements in children and caregivers. Methods: Families were provided with a low-cost digital scale and tape measure and a standardized protocol for remote measurements. Thirty-three caregiver and child (6-11 years old) dyads completed remote (at home) height and weight measurements while being observed via videoconferencing by research staff, as well as in-person measurements with research staff in the clinic. We compared the overall and absolute mean differences in child and caregiver weight, height, body mass index (BMI), and child BMI adjusted Z-score (BMIaz) between remote and in-person measurements using paired samples t-tests and one sample t-tests, respectively. Bland-Altman plots were used to estimate the limits of agreement (LOA) and assess systematic bias. Simple and multivariable regressions were used to examine whether sociodemographic factors and the number of days between measurements were associated with measurement discrepancies. Results: Overall mean differences in child and caregiver weight, height, BMI, and child BMIaz were not significantly different between remote and in-person measurements. LOAs were -2.1 and 1.7 kg for child weight, -5.2 and 4.0 cm for child height, -1.5 and 1.7 kg/m2 for child BMI, -0.4 and 0.5 SD for child BMIaz, -3.0 and 2.8 kg for caregiver weight, -2.9 and 3.9 cm for caregiver height, and -2.1 and 1.6 kg/m2 for caregiver BMI. Absolute mean differences were significantly different between the two approaches for all measurements. Child sociodemographic variables, caregiver education level, or time between measurements were not significantly associated with measurement discrepancies. Conclusions: Remotely observed weight and height measurements using non-research grade equipment may be a feasible and valid approach for pediatric clinical trials in rural communities. However, researchers should carefully evaluate their measurement precision requirements and intervention effect size to determine whether remote height and weight measurements suit their studies. Trial registration: ClinicalTrials.gov NCT04142034. Registered October 29, 2019