Building Consensus on the Essential Elements of the Musculoskeletal Physical Examination During Rheumatology Telehealth Encounters.

OBJECTIVE: Patients and providers encounter challenges when conducting virtual musculoskeletal physical examinations (PEs) during rheumatology telehealth encounters. Guidance for a structured virtual PE could enhance the quality of clinical information gleaned and management decisions made during rheumatology telehealth visits. This study aims to build expert consensus and identify the most essential elements as the first step in defining the virtual rheumatology musculoskeletal PE. METHODS: A team with expertise in rheumatology telehealth, consisting of rheumatology attending physicians, educators, and a patient with rheumatic disease, conducted a modified Delphi to achieve consensus on the items determined to be most essential to the virtual rheumatology musculoskeletal PE. The modified Delphi consisted of two online surveys and a virtual meeting. RESULTS: The team identified seven items essential to the rheumatology musculoskeletal telehealth PE. These items describe elements in a focused joint examination as well as the assessment for level of activity of inflammatory arthritis. The modified Delphi method excluded maneuvers related to assessment of muscle strength and widespread pain syndromes, determining that these elements were better conducted in person. CONCLUSION: A list of PE items most essential to rheumatology musculoskeletal telehealth encounters, supported by expert opinion and established evidence, marks the first step toward standardizing, evaluating, and teaching the virtual rheumatology PE. These items, alongside anticipated future revisions and improvements, promise to enhance the quality of telehealth care delivered to people with rheumatic diseases.

Duke Scholars

Author David Leverenz Medicine, Rheumatology and Immunology