Disclosures: Jami Montagnino, MD: No financial relationships or conflicts of interest

Objective: To assess the reliability of a standardized telemedicine knee exam compared to an in-person knee exam.

Design: Prospective, repeated measures, cross-over cohort study.Setting : An outpatient ambulatory sports medicine clinic.Participants : Adult patients presenting with unilateral knee pain. Patients were excluded if they could not safely perform a physical examination or if they had a history of knee surgery or a documented diagnosis of depression, anxiety, or chronic pain syndrome.

Interventions: All patients received both a physician-directed, self-administered telemedicine knee exam (TKE) and an in-person physician-administered knee exam (PKE). Exam components were standardized and the order of exam administration was randomized. The TKE was conducted via Zoom videoconference platform. During the TKE, patients received verbal guidance and were presented visual guides demonstrating exam maneuvers. For each patient, a different physician performed the TKE and PKE. Examiners remained blinded to results until the entire protocol was completed.

Main Outcome Measures: Inter-rater reliability of TKE and PKE measured by Cohen’s Kappa coefficient.

Results: Thirteen patients completed the protocol between June 2020 and May 2021. For 7 of 19 exam components, Cohen’s kappa coefficient showed a moderate degree of inter-rater reliability (k=0.62 -0.69), including pain with squatting, joint line tenderness, limited knee flexion, superior patellar pole tenderness, and pain with either flexion or extension. There was minimal to weak inter-rater agreement (k = 0.26-0.58) for 5 components, including patellar facet tenderness, knee extension, Thessaly Test, and single leg squat. There was no significant inter-rater agreement (k < 0.20) for the remaining 6 components, including presence of crepitus, presence of swelling, patellar compression, externally or internally rotated squat, alignment, and inferior patellar pole tenderness. Pooled kappa was 0.39.Conclusions: This study demonstrated weak to moderate reliability for TKE compared to PKE, therefore practitioners should exercise caution when interpreting knee exam findings conducted virtually.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/reliability-of-a-telemedicine-knee-exam/