To Zoom or not to Zoom? A retrospective comparative study to assess the validity of video versus face-to-face consultations and examinations for diagnosing lower back pain in Wales.

Abstract

A retrospective comparative study. To evaluate the accuracy of examination findings and diagnoses established after initial spinal consultations for low back pain conducted virtually in comparison with face-to-face (F2F) consultations. The COVID-19 (coronavirus disease 2019) pandemic required a shift from F2F to virtual consultations in healthcare, with documented benefits such as reduced costs, CO2 emissions, and time. However, the diagnostic accuracy of telemedicine for conditions requiring physical examinations, such as low back pain, remains underexplored. Although studies have highlighted the feasibility and high satisfaction of virtual spinal assessments, they have not thoroughly investigated their diagnostic accuracy. This study included 154 new patients with degenerative lumbar spine problems who were assessed via virtual consultations (VCs) (n=77) or F2F (n=77) by a single orthopedic spinal surgeon between May 2020 and January 2021. Patients were matched by age and sex, and examinations followed the "telemedicine musculoskeletal examination" protocol by the Mayo Clinic. Diagnostic changes from initial to definitive diagnoses were recorded and compared between the two groups. The diagnostic accuracy of VCs was comparable with that of F2F examinations, with no significant difference in the rate of diagnostic changes between the groups (p=0.814 for any change; p=0.405 for more significant changes). Motor deficits were the only examination component with significant false-positive rates in the VC group (p=0.023). The study findings indicate that the initial spinal VCs and examinations are effective, safe, and beneficial in the evaluation of low back pain, providing the same diagnostic accuracy as initial F2F consultations. All erroneous motor deficit findings were false positive, which means that no serious pathology was missed during the initial VC evaluation. Future research should focus on refining virtual examination techniques, particularly for assessing motor deficits.