Table 1 Summary of physical exam maneuvers and outcomes of the included studies organized by physical exam category. In the “Equivalence” column, “equivalent” means the telemedicine exam and the in-person exam were equivalent, “inferior” means the telemedicine exam was inferior to the in-person exam, and “NS” means the equivalence between the telemedicine exam and the in-person exam was not specified
From: A scoping review of the unassisted physical exam conducted over synchronous audio-video telemedicine
Category of physical exam | Study | Title | Specific exam maneuvers | Outcome measure | Equivalence |
|---|---|---|---|---|---|
Abdomen | Nachum 2019 | Use of Physician-Guided Patient Self-Examination to Diagnose Appendicitis: A Telemedicine Case Report. | Abdominal self-palpation | Comparison against in-person exam | Equivalent |
Cardiovascular | Cox 2013 | Assessing exercise capacity using telehealth: A feasibility study in adults with cystic fibrosis | 3-min step test | Comparison against in-person exam | Equivalent |
Cardiovascular | Seuren 2020 | Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis | Fluid retention (by the patient or relative feeling for leg edema), blood pressure with pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heartbeat indicator and put on by the patient or relative), oxygen saturation (using a finger clip device) | Explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology | NS |
Head and neck | Akhtar 2018 | Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study | Oropharyngeal coloration, posterior pharynx asymmetry, uvular deviation, oropharynx exudate, swelling, and ulceration, head and neck lymph nodes | Comparison against in-person exam | Inferior |
Multi-system | Bell 2016 | Telemedicine versus face-to-face evaluations by respiratory therapists of mechanically ventilated neonates and children: A pilot study | Pressure control, PEEP, mean airway pressure, breathing frequency, FIO2, inspiratory to expiratory time ratio (I-E ratio), tidal volume (VT), minute ventilation, oxygen saturation, presence of patient-triggered breaths, the need for suctioning or increased ventilator support | Comparison against in-person exam | Equivalent |
Multi-system | Duffy 1997 | Telemedicine and the diagnosis of speech and language disorders | Oral mechanism exam, motor speech exam, language exam | Summarize our speech pathology consultation-by-satellite experience, with emphasis on the methods used, information obtained, difficulties encountered and overcome, and types of speech and language problems that have been evaluated through this medium | NS |
Multi-system | Gallar 2007 | Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis | Catheter exit site appearance, dialysis fluid appearance, leg edema | Utility and cost-effectiveness of telemedicine in peritoneal dialysis | NS |
Multi-system | Jenkins 2001 | Assessing elderly patients with congestive heart failure via in-home interactive telecommunication | Assessment of respiratory effort, retraction, color of lips and nail beds, pedal and ankle edema | Comparison against in-person exam | Equivalent |
Multi-system | Schoenfeld 2016 | Variation in quality of urgent health care provided during commercial virtual visits | Ability to walk, tenderness at lateral malleolus, fever, tonsillar exudates, tender cervical adenopathy, suprapublic/flank/back pain | Completeness of histories and physical examinations via telemedicine, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions. | Inferior |
Multi-system | Siew 2016 | Reliability of telemedicine in the assessment of seriously ill children | Respiratory Observation Checklist consisting of age-appropriate tachypnea, perioral cyanosis, nasal flaring, tripoding, thoracoabdominal asynchrony, supraclavicular, substernal, and intercostal retractions, mental status, and overall impression of respiratory distress. Yale Observation Scale consisting of quality of cry, reaction to parent stimulation, state variation or ability to be aroused, color, hydration status, and response to social overtures. | Comparison against in-person exam | Equivalent |
Musculoskeletal | Abel 2017 | Can Telemedicine Be Used for Adolescent Postoperative Knee Arthroscopy Follow-up? | Knee range of motion, incision color, effusion size | Comparison against in-person exam | Equivalent |
Musculoskeletal | Cabana 2010 | Interrater agreement between telerehabilitation and face-to-face clinical outcome measurements for total knee arthroplasty | Scar assessment, swelling of knee joint, muscle strength, locomotion (Tinetti test), balance (Berg test) | Comparison against in-person exam | Equivalent |
Musculoskeletal | Goldstein 2019 | Video examination via the smartphone: A reliable tool for shoulder function assessment using the constant score. | Constant score (CS)—pain, activity level, arm positioning, strength (assisted by spring device, should exclude this), range of motion | Comparison against in-person exam | Equivalent |
Musculoskeletal | Good 2012 | Skype: A tool for functional assessment in orthopaedic research | Oxford shoulder score, Constant shoulder score | Comparison against in-person exam (the agreement had to do with the angle measurements) | Equivalent |
Musculoskeletal | Jacobson 2016 | Telehealth Videoconferencing for Children With Hemophilia and Their Families: A Clinical Project | Appearance of blood, swelling, range of motion | Evaluate the feasibility of using telehealth videoconferencing in children with severe hemophilia in the home setting. | NS |
Musculoskeletal | Lade 2012 | Validity and reliability of the assessment and diagnosis of musculoskeletal elbow disorders using telerehabilitation | Observations, self-palpate, conduct range of motion tests with self-applied overpressure, perform self-resisted static muscle tests, self-applied special orthopedic tests, self-applied ULNT tests | Comparison against in-person exam | Equivalent |
Musculoskeletal | Richardson 2017 | Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation | Self-palpation, self-applied modified orthopedic tests such as pain intensity with passive varus force by verbal guidance, active movements | Comparison against in-person exam | Equivalent |
Musculoskeletal | Russell 2013 | Internet-based physical assessment of people with Parkinson disease is accurate and reliable: a pilot study. | Timed stance test, Timed Up and Go test, step test, steps in 360 degree turn, Berg Balance Scale, lateral and functional reach test | Comparison against in-person exam | Equivalent |
Musculoskeletal | Steele 2012 | Assessment and diagnosis of musculoskeletal shoulder disorders over the internet | Postural analysis, joint palpation, range of motion (ROM) testing at the shoulder and adjacent joints, static muscle tests (SMTs), special orthopedic tests, neural testing, Hawkins-Kennedy impingement test | Comparison against in-person exam | Equivalent |
Musculoskeletal | Turner 2018 | Case Studies in Physical Therapy: Transitioning A "Hands-On" Approach into A Virtual Platform. | Range of motion | Feasibility of performing musculoskeletal exam over telemedicine | NS |
Neurologic | Abdolahi 2016 | A feasibility study of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders | MoCA | Comparison against in-person exam | Equivalent |
Neurologic | Ali 2013 | Accuracy of remote video cellphone evaluation of stroke deficits using california brief stroke scale | California Brief Stroke Scale (CABSS), a prehospital telemedicine instrument to rate stroke severity | Comparison against in-person exam | Equivalent |
Neurologic | Andrzejewski 2015 | Determining the reliability of performing the modified unified Parkinson's disease rating scale (UPDRS) remotely in a pilot virtual visit study in the home | Modified (excluding rigidity and postural instability) Unified Parkinson’s disease Rating Scale (mUPDRS) | Comparison against in-person exam | Equivalent |
Neurologic | Ball 1993 | Preliminary evaluation of a low-cost VideoConferencing (LCVC) system for remote cognitive testing of adult psychiatric patients | MMSE | Comparison against in-person exam | Equivalent |
Neurologic | Bove 2019 | Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis | Expanded Disability Status Scale (EDSS) | Comparison against in-person exam | Equivalent |
Neurologic | Bull 2014 | Conducting the montreal cognitive assessment remotely in Huntington's disease | MoCA | Comparison against in-person exam | Equivalent |
Neurologic | Bull 2014 | Monitoring fluctuations in motor function and mood hourly in Parkinson's disease via telemedicine | Modified version the Unified Parkinson’s disease Rating Scale (mUPDRS) | Correlation of mUPDRS with subjective mood and mobility ratings by patient on 1–10 scale | Equivalent |
Neurologic | Carotenuto 2018 | Cognitive Assessment of Patients With Alzheimer's Disease by Telemedicine: Pilot Study. | Italian versions of the MMSE and Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) | Comparison against in-person exam | Equivalent |
Neurologic | Castanho 2016 | Assessing Cognitive Function in Older Adults Using a Videoconference Approach | The Telephone Interview for Cognitive Status-Modified--Portuguese version (TICSM-PT) | Comparison of videoconference exam against telephone and in-person exam | Equivalent |
Neurologic | Cullum 2006 | Feasibility of telecognitive assessment in dementia | MMSE, Hopkins Verbal Learning Test-Revised, Clock Drawing Test, Digit Span, Category Fluency (fruits and vegetables), letter fluency (FAS and CFL versions), 15-item versions of the Boston Naming Test | Comparison against in-person exam | Equivalent |
Neurologic | Davis 2014 | Teleneurology: Successful Delivery of Chronic Neurologic Care to 354 Patients Living Remotely in a Rural State | Full neurologic exam with the exception of deep tendon reflexes, a careful sensory exam, retinal exam, or complete oral exam of palate movement | Patient satisfaction with teleneurology care as measured by a performance improvement satisfaction questionnaire | NS |
Neurologic | Davis 2019 | Using Teleneurology to Deliver Chronic Neurologic Care to Rural Veterans: Analysis of the First 1,100 Patient Visits | Mental status exam, cranial nerve exam (eye movements, nystagmus, eye closure strength, speech, protrusion of their tongue, and neck rotation), motor exam (bradykinesia and involuntary movement assessment, patients were asked to hold their arms outstretched, perform repetitive movements with fingers and hands, stand up from their chair without using their arms, and walk around the room), coordination and balance (walk tandem, perform a Romberg test, rapidly move their fingers in sequence, and perform finger to nose and rapid alternating movement tests) | Survey measuring quality of care, ease of communication, satisfaction, and staff’s ability to deliver same quality care as in person. | NS |
Neurologic | DeYoung 2019 | The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans. | Montreal Cognitive Assessment | Comparison against in-person exam | Equivalent |
Neurologic | Dorsey 2015 | Feasibility of virtual research visits in fox trial finder | Montreal Cognitive Assessment, MDS-UPDRS (excluding rigidity and balance) | Determine feasibility of virtual research visits, validate self-reported diagnosis of volunteers, and gauge satisfaction of neurologists and patients with visit through survey | NS |
Neurologic | Fraint 2019 | Reliability, feasibility and satisfaction of telemedicine evaluations for Cervical Dystonia. | Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale | Comparison against in-person exam | Equivalent |
Neurologic | Hubble 1993 | Interactive video conferencing: a means of providing interim care to Parkinson's disease patients. | Unified PD Rating Scale (UPDRS), Hoehn and Yahr score | Comparison against in-person exam | Equivalent |
Neurologic | Korn 2017 | Virtual visits for Parkinson disease: A multicenter noncontrolled cohort | Parkinson’s disease-focused exam | The primary outcome measures were feasibility, as measured by the proportion of visits completed as scheduled, and the 6-month change in quality of life, as measured by the Parkinson’s Disease Questionnaire 39. Additional outcomes included satisfaction with visits and interest in future virtual visits. | NS |
Neurologic | Lindauer 2017 | Dementia Care Comes Home: Patient and Caregiver Assessment via Telemedicine | MoCA | Comparison against in-person exam | Equivalent |
Neurologic | Loh 2007 | Development of a telemedicine protocol for the diagnosis of Alzheimer's disease | Standardized Mini Mental State Examination, Geriatric Depression Scale, Katz assessment of Activities of Daily Living, Instrumental ADL assessment, the Informant Questionnaire for Cognitive Decline in the Elderly | comparison against in-person exam, agreement for diagnosis of Alzheimer's between telemedicine and in-person exam | Equivalent |
Neurologic | McEachern 2008 | Reliability of the MMSE administered in-person and by telehealth | Mini-mental status examination (MMSE) | Comparison against in-person exam | Equivalent |
Neurologic | Montani 1997 | Psychological impact of a remote psychometric consultation with hospitalized elderly people | Mini-mental state exam (MMSE), clock face test (CFT) | Comparison against in-person exam | Inferior |
Neurologic | MunroCullum 2014 | Teleneuropsychology: evidence for video teleconference-based neuropsychological assessment | Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test-Revised, Digit Span forward and backward, short form Boston Naming Test, Letter and Category Fluency, Clock Drawing | Comparison against in-person exam | Equivalent |
Neurologic | Palsbo 2007 | Televideo assessment using Functional Reach Test and European Stroke Scale | European Stroke Scale (ESS), the Functional Reach Test (FRT) | Comparison against in-person exam | Equivalent |
Neurologic | Park 2017 | Korean Version of the Mini-Mental State Examination Using Smartphone: A Validation Study | Korean version of the Mini-Mental State Examination (MMSE-K) | Comparison against in-person exam | Equivalent |
Neurologic | Rudolph 2014 | Tablet computers address limitations of telestroke systems | NIH stroke scale | Comparison against in-person exam | Equivalent |
Neurologic | Shores 2004 | Identifying undiagnosed dementia in residential care veterans: Comparing telemedicine to in-person clinical examination | Focused neurological exam (gait, eye movements, hand tremor, and frontal release signs), short Blessed, three world recall, clock drawing | Agreement between in-person and telemedicine exams on diagnosis of dementia | Equivalent |
Neurologic | Stillerova 2016 | Remotely assessing symptoms of Parkinson's disease using videoconferencing: A feasibility study | Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) | Comparison against in-person exam | Inferior |
Neurologic | Stillerova 2016 | Could everyday technology improve access to assessments? A pilot study on the feasibility of screening cognition in people with Parkinson's disease using the Montreal Cognitive Assessment via Internet videoconferencing | MoCA | Comparison against in-person exam | Equivalent |
Neurologic | Tarolli 2018 | Virtual research visits in individuals with Parkinson disease enrolled in a clinical trial: React-PD study | Parkinson's disease motor and symptom assessments | Comparison against in-person exam | NS |
Neurologic | Timpano 2013 | Videoconference-based mini mental state examination: a validation study | Italian videoconference-based version of the Mini-Mental State Examination (VMMSE) | Comparison against in-person exam | Equivalent |
Neurologic | Vahia 2015 | Telepsychiatry for neurocognitive testing in older rural latino adults | Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test (HVLT)-Revised, Digit Span subtest from the Escala de Inteligencia de Wechsler para Adultos-Tercera Edicion, Letter and Category Fluency, Clock Drawing, Brief Visuospatial Memory Test (revised) (BVMT-R), Ponton-Satz Spanish Naming Test | Comparison against in-person exam | Equivalent |
Neurologic | VanHooff 2013 | Prehospital unassisted assessment of stroke severity using telemedicine: A feasibility study | Unassisted TeleStroke Scale (UTSS) | Comparison against in-person exam | Equivalent |
Neurologic | VanHooff 2013 | Unassisted assessment of stroke severity using telemedicine | Unassisted TeleStroke Scale (UTSS) | Comparison against in-person exam | Equivalent |
Neurologic | Venkataraman 2014 | Virtual visits for Parkinson disease: A case series | components of the Unified Parkinson’s Disease Rating Scale, such as remote analysis of rest tremor, action tremor, finger taps, hand movements, arising from chair, and gait | Feasibility, patient satisfaction | NS |
Neurologic | Wadsworth 2016 | Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment | MMSE, Clock Drawing, Digit Span Forward and Backward, Oral Trails, Hopkins Verbal Learning Test-Revised, Letter and Category Fluency, a short form Boston Naming Test | Comparison against in-person exam | Equivalent |
Neurologic | Weiner 2011 | Videoconference diagnosis and management of Choctaw Indian dementia patients | eyesight, hearing, facial expression, gait and station, coordination, tremor, rapid alternating movements, psychomotor activity, motor tests of executive function | Feasibility | NS |
Neurologic | Wong 2012 | The Rowland universal dementia assessment scale (RUDAS) as a reliable screening tool for dementia when administered via videoconferencing in elderly post-acute hospital patients | Rowland Universal Dementia Assessment Scale (RUDAS) | Comparison against in-person exam | Equivalent |
Neurologic | Wood 2013 | Can a low-cost webcam be used for a remote neurological exam? | Kurtzke Expanded Disability Status Scale (EDSS) | Comparison against in-person exam | Equivalent |
Neuropsychologic | Appleby 2019 | Feasibility of remote assessment of human prion diseases for research and surveillance | Telephone Interview for Cognitive Status (TICS), Medical Research Council (MRC) Prion Disease Rating Scale, Neuropsychiatric Inventory Questionnaire (NPI-Q), neurological exam | Acceptance, ease of use, and satisfaction of teleneurology among subjects and their caregivers | NS |
Neuropsychologic | Galusha-Glasscock 2016 | Video Teleconference Administration of the Repeatable Battery for the Assessment of Neuropsychological Status | Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) | Comparison against in-person exam | Equivalent |
Neuropsychologic | Hildebrand 2004 | Feasibility of neuropsychological testing of older adults via videoconference: Implications for assessing the capacity for independent living | Rey Auditory Verbal Learning Test (RAVLT)-T1, RAVLT- T6, RAVLT-LOT, CD, MR, BTA, CWAT, RAVLT-D, VOC | Comparison against in-person exam | Equivalent |
Neuropsychologic | Kirkwood 2000 | The consistency of neuropsychological assessments performed via telecommunication and face to face | National Adult Reading Test (NART) 11, the Quick Test, Forms 1 and 3, and sections of the Adult Memory and Information Processing Battery (AMIPB) 13, comprising Forms 1 and 2 of the following subtests: Story Recall, List Learning, Figure Recall, Information Processing | Comparison against in-person exam | Equivalent |
Neuropsychologic | Vestal 2006 | Efficacy of language assessment in Alzheimer's disease: comparing in-person examination and telemedicine. | Picture Description (auditory response version) (Boston Diagnostic Aphasia Examination [BDAE]) (Goodglass et al 2001), Boston Naming Test (BNT) (Goodglass et al 2001), Token Test (Multilingual Aphasia Examination) (Benton et al 2000), Aural Comprehension of Words and Phrases (Benton et al 2000), Controlled Oral Word Association Test (Benton et al 2000) | Comparison against in-person exam | Equivalent |
Not specified | Dixon 2008 | Virtual visits in a general medicine practice: A pilot study | not specified | Comparison against in-person exam | Inferior |
Not specified | Ohta 2017 | How Accurate Are First Visit Diagnoses Using Synchronous Video Visits with Physicians? | not specified | Agreement between in-person and telemedicine diagnoses | Equivalent |
Psychiatric | Grosch 2015 | Video teleconference-based neurocognitive screening in geropsychiatry | Mini-Mental State Examination (MMSE), Clock Drawing Test, Digit Span | Comparison against in-person exam | Equivalent |
Psychiatric | Loh 2004 | Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments | Standardized Mini-Mental State Exam (SMMSE), the Geriatric Depression Scale (GDS) | Comparison against in-person exam | Inferior |
Psychiatric | Menon 2001 | Evaluation of a portable low cost videophone system in the assessment of depressive symptoms and cognitive function in elderly medically III veterans | Geriatric Depression Scale short version (GDS), Hamilton Depression Scale (HAM-D), Short Portable Mental Status Exam (SPMSE) | Comparison against in-person exam | Equivalent |
Psychiatric | Singh 2007 | Accuracy of telepsychiatric assessment of new routine outpatient referrals | Not specified | Agreement of DSM-IV diagnoses, risk assessment, non-drug and drug interventions between telemedicine and in-person exams | Equivalent |
Skin | Edison 2008 | Diagnosis, diagnostic confidence, and management concordance in live-interactive and store-and-forward teledermatology compared to in-person examination | Not specified | Diagnostic and management agreement between in-person and telemedicine exams | Equivalent |
Skin | Lesher 1998 | Telemedicine evaluation of cutaneous diseases: a blinded comparative study. | Not specified | Agreement in diagnoses between the telemedicine and in-person groups. | Equivalent |
Skin | Marchell 2017 | Comparing High Definition Live Interactive and Store-and-Forward Consultations to In-Person Examinations | Not specified | Diagnoses, decisions to biopsy, and diagnostic confidence for teledermatology consultations vs in-person | Inferior |
Skin | Seghers 2014 | A prospective study on the use of teledermatology in psychiatric patients with chronic skin diseases | Not described, but likely only visual inspection. | Comparison against in-person exam | Equivalent |
Skin | Smith 2004 | Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients | Scar color, scar thickening, contractures, range of motion, breakdown of the graft site, activity level | Comparison against in-person exam | Equivalent |