Reliability and Accuracy of Telemedicine-Based Shoulder Examinations

• Published in: Journal of shoulder and elbow surgery 2022-08, Vol.31 (8), p.e369-e375
• Main Authors: Wang, Grace, Fiedler, Anna K., Warth, Ryan J., Bailey, Lane, Shupe, Paul G., Gregory, James M.
• Format: Article
• Language: English
• Subjects: reliability; Shoulder; telemed; telemedicine; televisit; virtual exam
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2022.04.005

Telemedicine has become a critical component in the evaluation and management of patients with shoulder pathology. However, interobserver reliability of findings on virtual physical exam relative to in-person evaluation are unclear. To determine the reliability of prerecorded video telemedicine for evaluation of shoulder pathology compared to traditional in-person physical exam. New patients presenting with unilateral shoulder pain to a single-surgeon shoulder clinic were recruited between July and November 2020. In one visit, patients were evaluated with standardized in-person and video-guided telemedicine physical exams with randomized order. Patients were evaluated for range of motion (ROM) and symptoms including pain, weakness, and apprehension. The telemedicine exam was recorded and consisted of a video guide displaying self-directed shoulder exam maneuvers that patients performed under remote coaching by an independent non-physician observer. The in-person physical exam was performed by the treating physician. The telemedicine videos were evaluated by two independent observers for inter-observer reliability. The treating physician subsequently evaluated the telemedicine videos after a minimum two-month washout period for intra-observer reliability and intra-platform reliability. Inter- and intra-observer reliability analyses were conducted using the Kuder-Richardson 20 (KR-20) formula. Specificity and likelihood ratios were calculated using p-value