Welcome to week two of Getting Back Better on Spine IQ’s Back Blog. Last week we initiated a conversation on telehealth and introduced guidelines that can equip the conservative spine practitioner to excel in the virtual health care realm. This week we’re spotlighting how to conduct a remote physical exam for spine-related disorders.
Before you begin scheduling virtual appointments with your patients, there are a number of important things that you need to consider. These include the laws/regulations in your state, potential malpractice restrictions, and staying current with the specific billing requirements for telehealth sessions, which are in flux due to the pandemic. It is also important to utilize video platforms that comply with privacy laws and to obtain patient consent, written or verbal, acknowledging the limitations of telehealth sessions. (1) Modifications to physical exam procedures like the lack of ability to perform a full neurologic evaluation, can contribute to these limitations. Beyond the examination however, clinicians and patients should be aware of other barriers that may arise like troubles with connectivity and unfamiliarity with new video conferencing platforms.
It has recently been observed that “while it is relatively straightforward to obtain an accurate patient history, the ‘remote physical exam’ is an oxymoron” (2). A face-to-face interaction offers a unique side to patient care that includes immeasurable pieces of the examination like social cues and body language that become lost during a virtual visit. During a telehealth appointment, it becomes essential for clinicians to balance the need for detail while maintaining patient rapport throughout subjective history taking and engaging in physical exam procedures. Translating medical jargon into patient friendly terms in a succinct manner while connecting with and educating patients through telehealth platforms is a challenge and takes some time to master. It’s recommended that clinicians share their thought process while acquiring objective findings so that patients are more comfortable and aware of the clinician’s end objective (2).
When it comes to performing a virtual physical exam, a host of modifications can be made to the large majority of objective tests making them more suitable for the virtual visit. For example, authors recommend conducting the global inspection and range of motion portions of the exam sequentially to make the best use of time and patient positioning. They also propose modifications to strength testing and outline variations for cervical and lumbar special testing procedures. Of note, the authors advise to avoid direct comparison between the quality of a virtual physical examination, and one conducted face-to-face as the virtual visit should be viewed in terms of its long-term efficacy, and not as a duplication. (2) It is important to continue delivering quality spine care to patients who do not have the option for in-office visits. To learn more about how to conduct a spinal telehealth evaluation, click here.
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- Haldeman S, Nordin M, Tavares P, Mullerpatan R, Kopansky-Giles D, Setlhare V, Chou R, Hurwitz E, Treanor C, Hartvigsen J, Schneider M, Gay R, Moss J, Haldeman J, Gryfe D, Wilkey A, Brown R, Outerbridge G, Eberspaecher S, Carroll L, Engelbrecht R, Graham K, Cashion N, Ince S, Moon E. Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative. JMIR Public Health Surveill. 2021 Feb 17;7(2):e25484. doi: 10.2196/25484. PMID: 33471778.
- Iyer S, Shafi K, Lovecchio F, Turner R, Albert TJ, Kim HJ, Press J, Katsuura Y, Sandhu H, Schwab F, Qureshi S. The Spine Physical Examination Using Telemedicine: Strategies and Best Practices. Global Spine J. 2020 Aug 5:2192568220944129. doi: 10.1177/2192568220944129. Epub ahead of print. PMID: 32755256.