BACKGROUND Telehealth visits (THVs) have made it essential to adopt innovative ways to evaluate patients virtually. This study validates a novel THV approach that uses educational videos and an instructional datasheet, enabling parents to use smartphones to measure their child's scoliosis at home or in telehealth settings. METHODS We identified a prospective cohort of patients with adolescent idiopathic scoliosis (AIS) scheduled for follow-up care from March to July 2021. The angle of trunk rotation (ATR) was first measured at home by patients' guardians using instructional video guidance and a smartphone application with internal accelerometer software. The second measurement was made during a THV examination performed by caregivers with supervision by trained associates via a telehealth appointment. Lastly, the clinician measured the child's ATR during an in-person clinic visit. Intraclass correlation coefficients (ICCs) and interrater reliability were compared between in-person clinic measurements and (1) at-home and (2) THV measurements. Shoulder, lower back, and pelvic asymmetry were observed and quantified at home and virtually, and then were compared with in-person clinic evaluations using kappa values. Surveys were used to evaluate the experience of the patient/caregiver with the at-home and telehealth assessment tools. RESULTS Seventy-three patients were included (mean age, 14.1 years; 25% male). There was excellent agreement in the ATR measurements between THVs and in-person visits (ICC = 0.88; 95% confidence interval [CI] = 0.83 to 0.92). ATR agreement between at-home and in-person visits was also excellent, but slightly diminished (ICC = 0.76; 95% CI = 0.64 to 0.83). Agreement between THV and in-person measurements was significantly higher compared with that between at-home and in-person measurements (p = 0.04). There was poor agreement in lower back asymmetry between THV and in-person assessments (kappa = 0.37; 95% CI = 0.14 to 0.60); however, there was no significant agreement between at-home and in-person assessments (kappa = 0.06; 95% CI = -0.17 to 0.29). Patient/caregiver satisfaction surveys (n = 70) reported a median score of 4 ("good") for comfort with use of the technology, and a score of 3 ("neutral") for equivalence of THV and in-person evaluation. CONCLUSIONS There was a high level of agreement between telehealth and in-person spine measurements, suggesting that THVs may be reliably used to evaluate AIS, thus improving access to specialized care. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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远程医疗环境中青少年特发性脊柱侧弯检查操作的验证。


背景 远程医疗访问 （THV） 使得采用创新方法来虚拟评估患者变得至关重要。这项研究验证了一种使用教育视频和教学数据表的新型 THV 方法，使父母能够在家中或远程医疗环境中使用智能手机测量孩子的脊柱侧弯。方法 我们确定了一个青少年特发性脊柱侧凸 （AIS） 患者前瞻性队列，计划于 2021 年 3 月至 7 月进行随访。躯干旋转角度 （ATR） 首先由患者的监护人在家中使用教学视频指导和带有内部加速度计软件的智能手机应用程序进行测量。第二次测量是在护理人员进行的 THV 检查期间进行的，并由训练有素的员工通过远程医疗预约进行监督。最后，临床医生在面对面的门诊就诊期间测量了孩子的 ATR。比较了面对面诊所测量与 （1） 在家和 （2） THV 测量之间的类内相关系数 （ICC） 和评分者间信度。在家中和虚拟观察和量化肩部、下背部和骨盆不对称性，然后使用 kappa 值与面对面的临床评估进行比较。调查用于评估患者/护理人员使用家庭和远程医疗评估工具的体验。结果 纳入 73 例患者 （平均年龄 14.1 岁;25% 为男性）。THV 和面对面就诊之间的 ATR 测量值具有极好的一致性 （ICC = 0.88;95% 置信区间 [CI] = 0.83 至 0.92）。在家就诊和面对面就诊之间的 ATR 一致性也非常好，但略有下降 （ICC = 0.76;95% CI = 0.64 至 0.83）。 与在家和面对面测量之间的一致性相比，THV 和面对面测量之间的一致性显着更高 （p = 0.04）。THV 和面对面评估之间的下背部不对称性一致性差（kappa = 0.37;95% CI = 0.14 至 0.60）;然而，在家评估和面对面评估之间没有显著的一致性（kappa = 0.06;95% CI = -0.17 至 0.29）。患者/护理人员满意度调查 （n = 70） 报告称，使用该技术的舒适度中位数为 4 分（“良好”），THV 和面对面评估等效性的中位数为 3 分（“中性”）。结论远程医疗和面对面脊柱测量之间存在高度一致性，表明 THV 可以可靠地用于评估 AIS，从而改善获得专业护理的机会。证据等级 诊断 II 级。有关证据级别的完整描述，请参阅作者说明。