Addressing safety and comprehensiveness concerns for neurological examination via telehealth in patients with low back pain

Low back pain (LBP) is a leading cause of disability globally. A neurological examination is standard practice in the assessment of patients with LBP-related symptoms, informing clinical diagnosis and management decisions. Failure to adequately identify neurological compromise can have serious consequences for the patient and health service alike. There has been a growing shift towards managing patients with LBP via telehealth (specifically video-conferencing), particularly in response to the global COVID-19 pandemic. While clinical experts have provided their perspectives regarding how individual neurological examination tests can be modified to a telehealth environment, no studies have formally established level of agreement when performing these tests via telehealth (compared to in-person examination).

Members of the RBWH Physiotherapy and Neurosurgery Departments (sponsored by the RBWH Foundation) came together to develop a telehealth examination proforma and to establish agreement of test outcomes between an in-person and telehealth environment.

A manuscript titled “Agreement between neurological examination findings performed via telehealth and in-person in people with low back pain” is currently in preparation.

The following education resources have also been developed to support translation of research findings into clinical practice, as well as to guide clinician decisions around the appropriateness of performing a neurological examination via telehealth.

Examination Proformas:

• Telehealth Neurological Examination Proforma
• In-person Neurological Examination Proforma

Video Resources:

The following video resources provide a demonstration of how each test was administered by both in-person and via telehealth, as described within the relevant examination proformas. NB. Tests were performed on a healthy individual for the purposes of technique demonstration.