Affiliations: [a] Department of Family Medicine, Eastern Virginia Medical School, Norfolk, VA, USA | [b] Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA | [c] Department of Orthopedics and Sports Medicine, Mayo Clinic, Jacksonville, FL, USA | [d] Department of Sports Medicine, Seattle University, Seattle, WA, USA | [e] Division of Rheumatology, Penn State Health, Middletown, PA, USA
Correspondence:
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Corresponding author: George G.A. Pujalte, MD, Department of Family Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA. E-mail: pujalte.george@mayo.edu.
Note: [1] Dr. Vomer is now with Duke University.
Abstract: BACKGROUND: Telehealth evaluations of musculoskeletal conditions have increased due to the stay-at-home policies enacted during the COVID-19 pandemic. Back pain is one of the most common complaints in primary care. While telehealth may never supplant in-person evaluation of back pain, it is imperative in a changing world to learn to perform this evaluation via telephone or video. Virtual visits rely on history-taking and patient self-reported descriptions of pain elicited from self-palpation or specific movements while on the telephone with the clinician. Video examinations provide a unique way of evaluating the lower back compared to telephone because of the ability to visualize the actions of the patient. OBJECTIVE: To create an evaluation pathway for examination of the lumbar spine via telehealth. METHODS: Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical lumbar examination elements, including inspection, palpation, range of motion, and strength, special, and functional testing. RESULTS: We have developed a table of questions and instructions and a glossary of images of each maneuver to facilitate lumbar spine examination via telemedicine. CONCLUSIONS: This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the lumbar spine.
Keywords: Lumbar, back pain, telehealth, virtual encounter, exam guide
