JMIR Publications

ABSTRACT

Background:

Access to care is often limited for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, an initial MSKD diagnosis may be challenging to make for clinicians since the physical examination and orthopaedic tests needs to be adapted and are performed remotely. No systematic review and meta-analysis has been performed to date to synthetize evidence regarding the initial assessment including a physical evaluation to remotely diagnose patients with MSKDs.

Objective:

To appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various musculoskeletal disorders.

Methods:

An electronic search was conducted up to August 2023, using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the QUADAS-2 tool. Random-effect model meta-analyses were performed. GRADE was used to synthesize the quality and certainty of the evidence.

Results:

Twenty-three concordance studies were eligible and included adult participants (n=1493) with various MSKDs. Based on high certainty, pooled Kappa and PABAK for the diagnostic concordance between remote and in-person assessments of MSKDs were respectively of 0.80 (95%CI: 0.72 – 0.89, 7 studies, n=353) and 0.83 (95%CI: 0.76 – 0.89, 6 studies, n=306). Based on moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95%CI: 0.80 – 0.99, 2 studies, n=142).

Conclusions:

The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use such as imaging tests are needed Clinical Trial: Prospero registration number: CRD42022335606