A scoping review of the unassisted physical exam conducted over synchronous audio-video telemedicine

Abstract

Background This scoping review aims to provide a broad overview of the research on the unassisted virtual physical exam performed over synchronous audio-video telemedicine to identify gaps in knowledge and guide future research. Methods Searches for studies on the unassisted virtual physical exam were conducted in 3 databases. We included primary research studies in English on the virtual physical exam conducted via patient-to-provider synchronous, audio-video telemedicine in the absence of assistive technology or personnel. Screening and data extraction were performed by 2 independent reviewers. Results Seventy-four studies met inclusion criteria. The most common components of the physical exam performed over telemedicine were neurologic (38/74, 51%), musculoskeletal (10/74, 14%), multi-system (6/74, 8%), neuropsychologic (5/74, 7%), and skin (5/74, 7%). The majority of the literature focuses on the telemedicine physical exam in the adult population, with only 5% of studies conducted specifically in a pediatric population. During the telemedicine exam, the patients were most commonly located in outpatient offices (28/74, 38%) and homes and other non-clinical settings (25/74, 34%). Both patients and providers in the included studies most frequently used computers for the telemedicine encounter. Conclusions Research evaluating the unassisted virtual physical exam is at an early stage of maturity and is skewed toward the neurologic, musculoskeletal, neuropsychologic, and skin exam components. Future research should focus on expanding the range of telemedicine exam maneuvers studied and evaluating the exam in the most relevant settings, which for telemedicine is trending toward exams conducted through mobile devices and in patients’ homes.

Telehealth Clinical Appropriateness and Quality

“…Further contributing to the mounting evidence to support incorporation of virtual physical examination maneuvers, two recently published scoping reviews of the literature have both concluded that the virtual physical examination has similar diagnostic accuracy and is largely equivalent to the in-person examination. 13 , 15 However, when considering the available data regarding the quality and value of the in-person physical examination, it raises the question of whether this should really be the gold standard in the first place. This is a topic garnering increasing attention, as leading authors in the field of digital health have begun to call for the development of a new “21st century” physical examination.…”

Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients

“…Furthermore, while previous studies comparing virtual and in-person physical exams have concluded that they may be equivalent, an in-person physical examination is sometimes necessary to evaluate the patient properly [ 48 ]. For example, new onset back pain would require an examination to evaluate for epidural disease and spinal cord compromise.…”

Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers

“…Although telemedicine has existed for decades, its use remained limited across physicians until the COVID-19 pandemic, during which changes in reimbursement and regulatory frameworks expedited the adoption of real-time audio-video platforms to provide medical services [4][5][6]. As the impact of telemedicine has reached a variety of specialties [7,8] and public awareness of its convenience has increased, many speculate that providers will continue to offer telemedicine options for some services in the future.…”

“…Telemedicine has been explored in a variety of uses, including but not limited to patient examination [7], teleconsultation [8], telesurgery [9] and medical education [10]. However, many users still do not view telemedicine as a substitute for in-person care; physicians cited limitations in diagnostic ability [11] and training [12][13][14], whereas patients cited limited interactivity and difficulty of access [15].…”