Reliability and Validity of Telehealth Spinal Examination Components: A Systematic Review

The purpose of this study was to systematically review the literature on the reliability or validity of telehealth spine examination components.

MEDLINE database from inception to May 17, 2022. Subject headings include virtual, telerehabilitation, telehealth, telemedicine, spine, spinal, neurologic, cervical, thoracic, lumbar, back, and examination. Studies not done synchronously, lacked comparisons to in-person, involved non-spine pathologies, or lacked reliability/validity were excluded. Reliability and validity data were captured using Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Quality and risk of bias were assessed with Quality Appraisal Tool for Studies of Diagnostic Reliability and the Scottish Intercollegiate Guidelines Network diagnostic accuracy checklist.

Six studies, with sample sizes of 11 to 100, were included. In 2 studies, Quality Appraisal Tool for Studies of Diagnostic Reliability was low, and the remaining were moderate to high. Two validity studies had high Scottish Intercollegiate Guidelines Network methodologic quality. Two studies suggested high validity and/or reliability for inspection, cranial nerve testing, pain localization, range of motion, deep neck flexion endurance, Lhermitte sign, and cervical spine neuroforaminal compression. Five studies suggested reliability for inspection, lower extremity muscle testing, pain localization, straight leg raise, Sorensen test, 5 repetitive sit-to-stand test, Lasègue test, reverse Lasègue test, Adams test, and pain on heel strike and poor postural inspection reliability.

This review found that components of telehealth spine examinations, such as those done in physical therapy or chiropractic clinical settings, were valid or reliable and provided support for clinical use.