Title: How Physical Therapists Use Telehealth to Conduct Musculoskeletal Assessments in the Era of COVID-19: A Mapping Review
Name: Haley Egan
Primary Presenters: Haley Egan
College of Health Sciences
Clinical Doctorate
Faculty Sponsor(s): Dr. Tamara Miller, Dr. Renee Mazurek
How Physical Therapists Use Telehealth to Conduct Musculoskeletal Assessments in the Era of COVID-19: A Mapping Review. Background: The COVID-19 pandemic has changed how healthcare is conducted across the United States. Physical therapy is among the many professions impacted by a shift towards utilizing Telehealth in place of office visits. Despite increased usage of this technology, guidelines on how to conduct a virtual musculoskeletal evaluation and assessment are not clear. Purpose: Conduct a mapping review of the literature pertaining to techniques used by physical therapists to remotely examine patients with musculoskeletal conditions. In doing so we hope to map out what tools are currently available for clinicians to use and how effective these tools are. Methods: Three researchers searched PubMed, Google Scholar, Lit COVID, UWM Libraries Database and Science Direct using the search terms musculoskeletal, evaluation, assessment, physical therapy, physiotherapy, telehealth, telemedicine, telerehab. Articles that met inclusion criteria underwent data extraction regarding participant characteristics, objective assessment tools, and outcome measures. Results: Eleven studies fulfilled the eligibility criteria. All were published between 2010-2021. The most commonly used assessments were self-palpation, observed range of motion, and modified special tests. The most common regions of the body were the knee and shoulder. Conclusion: Telehealth is a viable option for assessing certain orthopedic conditions in a high functioning patient population without balance concerns. More research is needed on the psychometrics of using these tests in comparison to in-person evaluation, and their application on lower functioning patient populations in order to ensure patient safety. Clinicians should be encouraged by the expanding capabilities of Telehealth and fully utilize the software available to them to create the best patient and provider experience. This platform should be seen for its possibilities for certain populations rather than just for its perceived limitations.
https://sites.uwm.edu/healthresearchsymposium/files/formidable/2/PT-Telehealth-COVID19_REFERENCES-1.pdf
I have to say, I have become a bigger proponent of telehealth (and tele-education!) during the pandemic. Based upon your findings in the mapping review I am curious to find out if you think there are areas of Physical Therapy practice that you would prefer to do via telehealth rather than in person?
From the perspective of a student, I think it would be nice if we could do the subjective portion of patient evaluations via telehealth and then follow-up with a more thoughtful objective examination in-person. This could provide additional time to sit with the information provided and refresh on the most psychometrically appropriate tests for the patient’s initial subjective presentation. We also read about the successes in completing follow-up visits via telehealth. With appropriate technology and internet connection, range of motion and postural assessments are easy to capture via telehealth and exercise-based treatments can easily be carried out online.
Great presentation, very aesthetically pleasing and succinct. As a physical therapy student, it is really great to know that these tools (albeit limited) exist for us in the era of pandemics and Zoom. Perhaps going forward, more people will opt for telehealth even when we are safe from COVID. What were some of the specific strength telehealth software assessments that you found in your review?
Hi Gabriel! We found a range of strength assessments during our research. Most of these methods contained little or no information on reliability or validity. Tests for general strength included AROM against gravity, AROM with common household objects of known weights, self-applied resistance, 30-second sit-to-stand, single leg squats, triceps chair push-ups, ability to dent a tennis ball with a squeeze grip, and a modified Biering-Sorenson Test. Counting reps provides a more objective measurement for future reassessment. Myotome-specific strength tests included toe walking, heel walking, side-lying hip abduction, hip extension, repeated toe raises, and single leg sit-to-stand. Lastly, Trendelenburg sign, performance during tandem gait, and performance on the Romberg test were also viewed as indicators of strength, although other factors could have influenced a poor performance.
Emilee, Jess and Haley, this is such an important topic! Sheila Schindler-Ivens, PT, PhD has put together a series of blogs reviewing the literature on the overall efficacy of telephealth in PT, and certainly in some populations telehealth is actually MORE effective. I appreciate your approach to look at the validity of examination approaches that can be used in telehealth. I’ve actually never heard of a mapping review before. It is very interesting. Great job!