For patients with adolescent idiopathic scoliosis (AIS), could certain aspects of the spine examination be reliably conducted via telemedicine? Dr. Matt Schmitz, JBJS Deputy Editor for Social Media, reflects on a new study that provides preliminary validation of a novel approach.
The Covid pandemic was, without a doubt, a catastrophic experience across the globe. But the catastrophe did yield innovations within medicine with lasting impacts. Among these: the significant increase in the use of telemedicine for patient encounters.
With the rise of telehealth visits (THVs), their use in the orthopaedic setting for certain “physical exams” needs to be validated. In the December 4, 2024 issue of JBJS, investigators from Boston Children’s Hospital report on a novel method for evaluating patients with adolescent idiopathic scoliosis (AIS) through virtual means. The protocol incorporates educational videos and an instructional datasheet as well as the use of smartphone technology for measuring a child’s scoliosis at home and during telehealth appointments. You can read the study, by Farid et al., at JBJS.org:
Validation of Examination Maneuvers for Adolescent Idiopathic Scoliosis in the Telehealth Setting
The study included a prospective cohort of 73 patients with AIS (mean age, 14.1 years; range, 11.4 to 18.0 years; 25% male) who were scheduled for routine follow-up care from March to July 2021.
Measurements of the angle of trunk rotation (ATR) were made at home by caregivers using a smartphone application with internal accelerometer software; during a THV by caregivers under clinician supervision; and by the clinician during an in-person visit. The researchers compared intraclass correlation coefficients (ICCs) and interrater reliability between the in-person clinic measurements and both the at-home and THV measurements. Shoulder, lower back, and pelvic asymmetry were also assessed. Patient and caregiver experiences were evaluated through surveys.
Study Findings
- ATR measurements: The investigators found excellent agreement in measurements between THVs and in-person visits (ICC = 0.88) and excellent, but slightly diminished, agreement between at-home and in-person visits (ICC = 0.76). The agreement between THV and in-clinic measurements was significantly higher than between at-home and in-clinic measurements (p = 0.04).
- Asymmetry assessments: In terms of lower back asymmetry, poor agreement between THV and in-person assessments was found (kappa = 0.37), with negligible agreement between at-home and in-person assessments (kappa = 0.06). No significant agreement in measurements of shoulder or pelvic asymmetry was found (at-home or THV vs. in-person).
- Satisfaction scores: Surveys indicated a median score of 4 (“good”) for comfort using the technology and a score of 3 (“neutral”) for equivalence between THVs and in-person assessments.
The findings suggest that ATR measurements for patients with AIS can be reliably assessed via telehealth visits, thus enhancing access to specialized care. However, the assessment of asymmetry, particularly with at-home evaluation, showed lower agreement, indicating a need for further refinement in telehealth strategies.
In addition to the small sample size (73 patients), potentially limiting generalizability, there was a notable early learning curve associated with use of the technology. The authors point out additional challenges, including data security concerns and potential disparities in access to technology affecting certain populations. Despite its limitations, however, this study lays the groundwork for integrating telemedicine into routine AIS management, which may be particularly beneficial to patients facing barriers to traditional care.
Overall, the study demonstrates the promising potential of THVs in pediatric orthopaedics, particularly for routine follow-up in AIS management, while emphasizing the need for continued development of telehealth protocols. If there is any “positive” from the pandemic, we as surgeons now have additional tools to put to use in our efforts to improve patient interactions and care.
Read the full study: Validation of Examination Maneuvers for Adolescent Idiopathic Scoliosis in the Telehealth Setting
Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media
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