title: The diagnostic accuracy of telerehabilitation for nonarticular lower-limb musculoskeletal disorders.
abstract: OBJECTIVE
  Musculoskeletal conditions are highly prevalent and disabling, particularly in rural and remote areas. In these areas, access to rehabilitation services is limited by the availability of physical therapists. Telerehabilitation may be a feasible solution to the issue of rural physical therapy service access; however, there is little existing evidence for clinical efficacy. The aim of this study was to establish the criterion validity and reliability of remote physical assessment and diagnosis of nonarticular lower limb musculoskeletal conditions via telerehabilitation.
  
  
  METHODS
  Nineteen participants with existing nonarticular lower limb musculoskeletal conditions were assessed by a face-to-face therapist and a remote therapist to establish criterion validity of telerehabilitation. Video recordings from the telerehabilitation session were reviewed after 1 month by the remote therapist to establish intrarater reliability and by a second remote therapist to establish interrater reliability. Patho-anatomical diagnoses, system diagnoses, and the findings of the physical examination were compared statistically.
  
  
  RESULTS
  There was 79% or higher primary diagnosis agreement (same or similar diagnoses) and 79% or higher exact system diagnosis agreement for validity, intrarater reliability, and interrater reliability studies. The physical examination findings showed substantial agreement (0.61 < kappa < 0.80) in the validity study and almost perfect agreement (0.81 < kappa < 1.00) in the intrarater and interrater reliability studies.
  
  
  CONCLUSIONS
  Using telerehabilitation for musculoskeletal physical therapy assessment of nonarticular lower limb conditions was found to be valid and reliable. Existing diagnostic reasoning can be applied; however, new methods of patient self-examination are needed to enable differential diagnosis.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia. t.russell@shrs.uq.edu.au
authors.forename: Trevor
authors.initials: T
authors.lastname: Russell
authors.forename: Piers
authors.initials: P
authors.lastname: Truter
authors.forename: Robert
authors.initials: R
authors.lastname: Blumke
authors.forename: Bradley
authors.initials: B
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005684:Gait; D006801:Humans; D020407:Internet / Q000458:organization & administration; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation; D015588:Observer Variation; D017060:Patient Satisfaction; D010808:Physical Examination / Q000379:methods* / Q000523:psychology; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D011793:Queensland; D016059:Range of Motion, Articular; D019114:Remote Consultation / Q000458:organization & administration*; D016353:Self-Examination; D049269:Videoconferencing