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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.