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Journey of a DPT Student

The Skype Diagnosis

Published February 6, 2013 10:30 AM by Lauren Rosso

This weekend I had to stretch my already-struggling assessment skills to the virtual world during a Skype session with my uncle. He's been having shoulder pain for the past few weeks and sought out my opinion via e-mail. We chatted back and forth about his symptoms, onset and pain, and he eventually tricked me into the session by suggesting that we Skype so I could see my 1-year-old cousin. Turns out he had a hidden agenda.

First of all, my confidence with all things outpatient musculoskeletal is at an all-time low. I haven't been in that sort of setting for a year now, and even when I was there I felt my assessment skills were lacking most of all. This was and is particularly highlighted with shoulder pathology. Maybe it's because we covered the shoulder in such a short time period and I didn't have the chance to assess many patients after the didactic portion was complete. Either way, when faced with the "video" eval, I was caught off guard. Luckily I had my notes within reach and my uncle, understanding that I'm still a student, was as patient as ever. (Hey -- he got a free assessment so he can't complain).

What I really took away from the experience was how valuable it is to be physically present during a patient assessment. It was so much more difficult to figure out even the most basic ROM restrictions without being able to place my hands on my "patient." The Skype session was, however, a great lesson in communication and trying to explain special tests and exercises with only the use of words. It's definitely something I need to work on, but for now I'll appreciate my face-to-face patient time, at least while I'm still in the learning phase.


Actually, Lauren is correct in that shoulder MSK diagnosis is most difficult.  In a study by Dr. Trevor Russell, MSK diagnosis via telehealth is most challenging for shoulder while both knee and ankle MSK conditions had the highest levels of validity and reliability in telehealth.  Also, based on telehealth and telemedicine guidelines, Skype is not the best means of HIPAA compliance. Take a look at APTA's telehealth resources at:

Alan Lee, , physical therapist Scripps Mercy July 8, 2014 4:18 PM
San Diego CA

Having performed two "Skype Evals" with my own family members recently, I am in complete agreement with the need to perform initial evaluative measures in person. My mom was experiencing shoulder pain and was not able to peform her usual two day a week yoga routine, so I said lets Skype so I could visually see what motions were causing her pain. After taking a brief history, I realized I was going to need a third party to help with passive ROM and special testing measures. Luckily, my dad was at home at the time and he graciously agreed to help out. AROM was easy to assess because I could emmulate the motions, but explaining to my dad how to passively move her shoulder while she was trying to relax was a bit more difficult. My dad was able to do special testing with specific directions, but how accurate I'm not sure.

Overall, I was able to gain the necessary information to form a diagnosis, prognosis, and plan of care, but the evaluation took twice as long as usual and required me to be very creative with verbal directions/computer placement. If I was going to perform a Skype evaluation on an actual patient I would recommend the third party have previous physical therapy training or observation experience to perform the necessary testing accurately. Skype is a great tool for evaluation/treatment of patients who live in remote locations or cannot travel secondary to disability or no transportation. If I get the chance in the near future based on where I work, I would like to incorporate this form of patient care into my practice of PT.

Jessica Foster March 14, 2013 12:59 PM
Greenville NC

I agree with both of you.  There is definitely value in being able to assess your patient in person.  However in the case of the PT working with patients  in the Caribbean, I suppose anything is better than nothing.  

The way I see tele-health being most effective is after an initial evaluation is performed in person.  There are likely a ton of intervention strategies and re-evaluation measures that can be collected without being "in person", but to start the plan of care, I think it's important for the patient to be seen in the clinic.  That's just me opinion though!

Lauren Rosso March 9, 2013 4:16 PM
Pittsburgh PA

It is interesting to read your perspective on video evaluations.  I met a PT who was just starting to offer some PT services via video conference for an island in the Caribbean that had no physical therapy available on the island.  The people on the island had many injuries due to poor mechanics while heavy lifting, which was a prevalent requirement of jobs in their community.  The PT was struggling with the best way to offer her expertise and assistance to people in need without living there full time.  She was fortunate to know a personal trainer who lived on the island and was willing to help.  The arrangement they had worked out when I last spoke to her was for the PT to visit a few weeks out of the year to evaluate new patients and check up on any current patients while the trainer would help the patients carry out any exercise programs prescribed by the PT while the PT was in the States.  Periodically the patients and personal trainer would video chat session with the PT so that the PT could try to make some assessment about progression of the exercise protocol.  

It seems to me that many evaluative measures would be difficult--even with a third personal available to help measure and place the patient--since many assessments, like accessory motions, are based on the way a body feels to the trained PT.  Similarly, treatment would be necessarily limited to things like exercise and stretching since the personal trainer has neither the training nor the equipment available to PTs.  Nevertheless, this kind of approach may be helpful for providing at least some service to people in under-served areas at least until a physical therapist moves to the area or a local is trained in the profession.  I am interested to see how video sessions with patients will develop, but I am still a firm believer that the services of a PT will be much more effective when the PT can physically touch the patient during both evaluation and treatment.

Caitlin, DPT Student March 7, 2013 5:49 PM
Greenville NC

I absolutely agree that "hands on" therapy session with a patient is optimal and should be performed first as long as their are no conflicting issues. Problem with the "wireless" examination is most patients are unaware of the information we are trying to collect from this exam and may exclude this information. Although, I would agree that this would be an excellent learning experience in communication with the patient.

Since I am far from a master clinician, I would be interested to see their point of view on this issue. If they found it feasible to perform these examinations, it could really help distant areas that are in need of physical therapy.

Tyler, DPT Student March 6, 2013 2:45 PM
Greenville NC

Hey Dean- I think it's a great option for experienced clinicians, but I think it would be a huge challenge for new graduates.  There was so much that I felt I was missing by not being able to have an actual "hands on" evaluation.  However, a great cost-cutting measure!!

Lauren Rosso February 15, 2013 9:48 AM

Based on this experience, what do you now think of 'tele-physio' that you heard me talk about whilst you were in the UK?

Dean Metz February 13, 2013 1:06 PM

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