Back pain is a frequently occurring and disabling condition for people in rural and remote areas. In these areas, access to rehabilitation services is limited by service availability. Telerehabilitation is proposed as a solution for providing physical therapy services; although, the validity of clinical assessment is largely unproven. The goal of this study was to establish the validity of clinically pragmatic remote assessment of spinal posture, active movements of the lumbar spine, and the passive straight leg raise (SLR) test. Face-to-face physical therapist assessment was compared with telerehabilitation assessment of spinal posture, active movements of the lumbar spine, and the SLR test. Twenty-six participants recruited from a rural population with current or recent low back pain (LBP) were assessed by a face-to-face physical therapist and a remote physical therapist. Pain, disability, and clinical measurements were assessed. Outcomes were compared to establish agreement. High levels of agreement were found with detecting pain with specific lumbar movements, eliciting symptoms, and sensitizing the SLR test. Moderate agreement was found with identifying the worst lumbar spine movement direction, SLR range of motion, and active lumbar spine range of motion. Poor agreement took place with postural analysis and identifying causes for limitations to lumbar movements.
This study, which was conducted in a clinical and rural setting, validates elements of the physical assessment of the lumbar spine and identifies technical and clinical issues to be dealt with in future research. It concluded that significant components of the standard musculoskeletal assessment of LBP are valid via telerehabilitation in a clinical setting.