Can we examine a player’s hip via telehealth ?

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.

To learn more about disease, complete the ‘Infectious diseases’ module in the FIFA Diploma in Football Medicine.

Reference
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

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ami malka
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ami malka

Thank you for the information
So in this study they not use only video call? They suggest only investigation or also a treatment?

إيهاب حفناوي
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ممتاز جدا

Willy Gálvez A
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Willy Gálvez A

Excelente información

Miguel Ángel
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Miguel Ángel

Gracias por tan importante información

Vishnu
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Vishnu

Thanks for this post.

As the conclusion states that the methods of examining the players via SAE in comparison with SCE were statistically insignificant because of limited sample size, does this mean that the practitioner can use SAE as an alternative to the standardised clinical examination?

Dr Shahram Mohaghegh
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Dr Shahram Mohaghegh

Hi, I think It means there is just a statistical not clinical significant difference between two methods and accordingly can not be concluded which method is better.

ALIREZA KESHMIRI
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like

Mariu
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Mariu

thanks a lot… Creo que la clave esta en un buen interrogatorio o anamnesis efectivo de la clínica del paciente para poder ser certeros en el diagnóstico con las limitaciones del caso ya referidas.

bangoura
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bangoura

AVEC L EXPENTION DU COVID19 IL SERAIT PLUS OU MOINS COMPLIQUE VOIR DIFFICILE DE FAIRE DES CONSULTATIONS PHYSIQUES CHEZ LES SPORTIFS TRAUMATISES EN GENERAL ET EN PRTICULIER CEUX SOUFFRANT DU TRAUMATISME DE LA HANCHE. A PART LES CAS D ENTORSE BENIGNE DE CONTUSION OU LE MEDECIN DE CLB PEUT PAR TELE MEDECINE METTRE EN BATTERIE TOUT UN ARSENAL DE SOINS AVEC LE PHYSIOTHERAPEUTE LE MASSEUR ET METTRE UN TRAITEMENT A DISTANCE ET AVOIR UN BON RESULTAT. DANS LES CAS PLUS SERIEUX OU IL FAUT FAIRE RECOURS ÀUX IMAGERIES UNE TELE MEDECINE SERAIT TRES DIFFICILE A REALISER SANS LA PRESENCE DU… Read more »

JUMA MOHAMMED ABDAN AL HINAI
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JUMA MOHAMMED ABDAN AL HINAI

Very good information

Ahmed almayali
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I would like to participate

Ehab
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Ehab

شكرا

Abdelhak Assem
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Abdelhak Assem

very nice

SAID MOHAMD SALIMAN
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SAID MOHAMD SALIMAN

Of course, the diagnosis is indispensable from the injured player’s speech besides the clinical examination

SAID MOHAMD SALIMAN
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SAID MOHAMD SALIMAN

A useful article in these difficult circumstances. Greetings and thanks

Ahmed Abikchi
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Ahmed Abikchi

Merci

Mohamed Abd el Rahman Mohamed Elazouny
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Mohamed Abd el Rahman Mohamed Elazouny

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HD
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HD

ممتاز جدا