Telehealth for Musculoskeletal Conditions: What Can and Can't Be Assessed Remotely

What Remote Care Involves

Telehealth for musculoskeletal problems usually means a real-time video consultation in which a clinician takes a history, observes the person move, guides some tests and prescribes or supervises exercise. It cannot replicate hands-on assessment, but it can do more than many people expect.

A good remote consultation relies heavily on the history, which often provides most of the useful information in musculoskeletal care, and on simple observable tasks such as walking, squatting, reaching or standing on one leg. A well-lit space, a camera angle that shows the whole body and a few minutes of setup make a noticeable difference to what can be seen.

What Appears to Hold Up Remotely

A systematic review of studies of internet-based physiotherapy assessment found that measures such as pain, swelling, range of motion, muscle strength, balance, gait and functional assessment showed good concurrent validity, meaning they agreed well with the same measures taken in person. Overall the reviewed assessments showed good validity and excellent reliability, and the included studies were of moderate to good methodological quality (Mani et al., 2017).

What Is Harder to Do Well

The same review reported lower concurrent validity for lumbar spine posture, special orthopaedic tests, neurodynamic tests and scar assessment (Mani et al., 2017). This fits with what would be expected: tests that rely on palpation, applied force, or a clinician's hands feeling the response are difficult to reproduce through a screen. Hands-on techniques cannot be delivered remotely at all. Findings from a remote assessment are therefore often best treated as a working picture that may be refined in person.

Does Remote Rehabilitation Work?

A systematic review and meta-analysis of real-time telerehabilitation for musculoskeletal conditions, covering 13 studies, concluded that it appeared effective and comparable to conventional delivery for improving physical function and pain. Treatment delivered solely by telerehabilitation was equivalent to face-to-face care for physical function in the pooled analysis, although the studies varied considerably and the authors noted high heterogeneity for some outcomes (Cottrell et al., 2017).

Telehealth is not suitable for every situation. Sudden severe symptoms, a suspected fracture, neurological changes or other concerning features need prompt in-person medical attention rather than a video appointment. Whether remote care is appropriate for a particular problem is best discussed with the treating clinician.