The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

Abstract

The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine’s capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers’ confidence in incorporating telemedicine into their practice.

Barriers and Facilitators to the Acceptance of eHealth Interventions by Dutch Pediatric Physical Therapists in Times of the COVID-19 Pandemic: A Mixed-Methods Approach

“…Within the theme of performance expectancy, the subthemes pediatric therapeutic acting, communicating, and organizing were identified as barriers to the acceptance of eHealth interventions. These findings support previous research in pediatric physical therapy, which demonstrated that pediatric physical therapists using telehealth are unable to gather the necessary information to perform a physical examination 17,18. Moreover, similar results of communication issues and additional work at a practical level were found in recent studies 10.…”

“…These findings support previous research in pediatric physical therapy, which demonstrated that pediatric physical therapists using telehealth are unable to gather the necessary information to perform a physical examination. 17 , 18 Moreover, similar results of communication issues and additional work at a practical level were found in recent studies. 10 Furthermore, within the theme of facilitating conditions, restriction in terms of cost and technical difficulties were identified as barriers to the acceptance of eHealth interventions complementing previous research, which shows that technical difficulties limit eHealth use.…”

Pediatric Telemedicine

“… 18 , 29 For primary care and non-urgent conditions, a review of pediatric musculoskeletal tele-assessments found that minimizing background noise and distractions, gathering items the child can use to demonstrate fine motor skills, ensuring the child is dressed in comfortable clothing, and preparing children for what to expect can help to facilitate an effective exam. 30 Other published studies found virtual exams to be effective for diagnosing and treating common musculoskeletal conditions. 29 Eye exams have also been conducted virtually during the pandemic for children, relying on parents to position their child’s eye in the camera.…”

Video-Conference-Based Graphomotor Examination for Children: A Validation Study

“…In addition, the results of the correlational analyses conducted across the entire sample and for each gender separately, between the GIFT-Online and other observational tools, namely the DCDQ’07/LDCDQ and the DPSQ, were also similar to the in-person GIFT version (Gilboa, 2017); thereby reinforcing the concurrent validity of the GIFT-Online. A recent narrative review of a musculoskeletal examination for children aged 3 to 18 conducted via telemedicine concluded that examinations performed in video-conference calls have been shown to have high inter- and intra-rater reliability, and concurrent validity, when compared with in-office visual evaluation (Noutsios et al, 2021).…”