The validity of physical therapy assessment of low back pain via telerehabilitation in a clinical setting

Abstract

Background: Back pain is a common and disabling condition for people in rural and remote areas. In these areas, access to rehabilitation services is limited by service availability. Telerehabilitation is suggested as a solution for providing physical therapy services; however, the validity of clinical assessment is largely unproven. The aim of this study was to establish the validity of clinically pragmatic remote assessment of spinal posture, active movements of the lumber spine, and the passive straight leg raise (SLR) test. Subjects and Methods: Face-to-face physical therapist assessment was compared with telerehabilitation assessment of spinal posture, active movements of the lumbar spine, and the SLR test. Twenty-six participants recruited from a rural population with current or recent low back pain (LBP) were assessed by a face-to-face physical therapist and a remote physical therapist. Pain, disability, and clinical measurements were assed. Outcomes were compared to establish agreement. Results: High levels of agreement were found with detecting pain with specific lumber movements, eliciting symptoms, and sensitizing the SLR test. Moderate agreement occurred with identifying the worst lumber spine movement direction, SLR range of motion, and active lumber spine range of motion. Poor agreement occurred with postural analysis and identifying reasons for limitations to lumbar movements. Conclusions: Conducted in a rural clinical setting, this study validates elements of the physical assessment of the lumbar spine and identifies technical and clinical issues to be addressed by future research. Important components of the standard musculoskeletal assessment of LBP are valid via telerehabilitation in a clinical setting.