With the current constraints imposed by the global COVID-19 pandemic, football players and their teams have more restricted access to their doctors and physiotherapists. As a result, many clinicians have continued to practice via telemedicine. The purpose of the paper highlighted in this week’s FastFact was to evaluate the diagnostic accuracy of a self-administered examination for patients thought to have hip-related pain1.
A total of seventy-five patients presenting with hip pain were assessed via both a self-administered examination (SAE) and then a more traditional standardised clinical examination (SCE). The SAE was done ‘face to face’ with a clinician, rather than via a telehealth platform. A diagnosis of femoroacetabular impingement syndrome (FAIS) was defined according to the Warwick Agreement (the presence of hip pain, clicking, catching or stiffness which is reproduced with impingement testing, in the presence of cam or pincer morphology on x-ray in the absence of radiographic osteoarthritis).
The study’s authors report that the diagnostic accuracy of both clinical examination protocols was limited and did not influence the post-test probability of a diagnosis of FAIS. The accuracy of the patient SAE was actually statistically higher than that of a traditional clinician-performed examination. The difference was however small and is unlikely to be clinically relevant.
There are a number of obvious limitations associated with this study. Firstly, the sample is small and is unlikely to reflect a young football-playing population, particularly elite or professional players. The relatively limited impact of both the examination techniques on the eventual diagnosis must be noted. This highlights the need for a good history (which is possible via telehealth) and access to imaging (which may also be available via telehealth). Finally, the SAE was not administered via telehealth and whether this protocol can be reliably done via this medium remains unknown.
This study suggests that the clinical examination of players with hip and groin pain is no worse when using a SAE. This may allow clinicians to have more confidence when making clinical decisions via a telehealth platform. During the current COVID-19 related shutdown this may have a significant impact on the ongoing provision of care . Providing the patient the SAE instructions prior to a consultation, so they can prepare in advance, may be a way of making this type of assessment more successful.
1. Owusu-Akyaw KA, Hutyra CA, Evanson RJ, et al Concurrent validity of a patient self-administered examination and a clinical examination for femoroacetabular impingement syndrome BMJ Open Sport & Exercise Medicine 2019;5:e000574. doi: 10.1136/bmjsem-2019-000574