Telehealth physical examinations show comparable accuracy and results to clinical exams for MRI confirmed shoulder pathologies

Abstract

Introduction

The purpose of this study is to measure the comparative diagnostic accuracy of telehealth diagnostic examinations for pathologies of the shoulder against an in-person examination. The telehealth examinations were hypothesized to be non-inferior to in-person examinations for accuracy and to demonstrate fair to moderate agreement. This is an expanded study of a data set included in a prior publication.

Methods

Patients underwent in-person standardized clinical examination (SCE) and standardized telehealth examination (STE) during the same visit by two different providers in randomized order. Tests were analyzed for sensitivity, specificity, agreement, and diagnostic accuracy using a nonarthrographic shoulder MRI as a reference standard, and divided into tests for rotator cuff tears (RCTs), glenohumeral arthritis (GHA), and acromioclavicular (AC) joint arthropathy. A pooled diagnostic accuracy was created for SCE and STE and directly compared using a Mann–Whitney U test.

Results

Sixty-two patients, average age of 57.9 years (±11.2), with 60 patients obtaining an MRI, were included in this study. There were no significant differences in the pooled diagnostic accuracy of identifying RCT, GHA, or AC arthropathy between SCE and STE (P = .495, .469, .333, respectively). The highest agreement between SCE and STE was observed for the shoulder shrug test, night pain, and internal rotation limitation for identifying RCT.

Discussion

STE demonstrated non-inferior pooled diagnostic accuracy in comparison to SCE for full-thickness RCT, GHA, and AC joint arthropathy. Secondarily, there was moderate to substantial agreement for selective tests, with a considerable portion ranging from fair to substantial agreement.