Agreement on clinical examination and management between virtual videoconferencing and in-person assessment in a...

This study examined the intra and inter-examiner agreement of clinical tests and a management plan between a virtual video encounter and an in-person assessment in patients seen at a specialty shoulder program at an academic center.

Participants were evaluated using a web-based video conferencing program and an in-person assessment. Guidelines on proper positioning of the camera and specific tests were outlined and sent in advance to all patients. Range of motion (ROM) was documented. Shoulder-specific clinical signs examined rotator cuff and proximal biceps tendon. Management was categorized as nonoperative or operative. Intraclass correlation coefficients and Kappa coefficients (κ) were used.

Thirty patients, 14 (47%) females, mean age: 57.5 (SD = 11), were examined twice. The intraclass correlation coefficients values ranged from 0.83 to 0.87 for shoulder ROM, indicating good reliability. Cervical spine Spurling test had an almost perfect agreement (κ = 0.83). The κ values were substantial for the hornblower sign (κ = 0.78), painful arc (κ = 0.65), lift-off test (κ = 0.65), and belly press test (κ = 0.61). Agreement was moderate for the cervical spine ROM (κ = 0.60), Jobe's test (κ = 0.57), Hawkins-Kennedy (κ = 0.52), and cross-body adduction (κ = 0.47). The management plan showed almost perfect agreement with respect to conservative vs. surgical management (κ = 0.83). Percentage of agreement for inter-examiner agreement ranged from 0.80 to 1.00.

The majority of shoulder clinical tests for rotator cuff pathology conducted via a structured video encounter were shown to be reliable. The resulting proposed management plans were essentially identical.