242. Telehealth: comparison of physical exam between telehealth visits and in-person visit for patients with spine pathology

BACKGROUND CONTEXT History, physical exams (PE) and imaging are used to diagnose spine pathology. There is limited data on differences in telehealth physical exam findings when compared to in person physical examinations in the same patient. Further analysis is required to determine differences in telehealth visits (TV) and office visits (OV) examinations and the clinical significance of these differences. PURPOSE To determine differences in TV and OV examinations and the clinical significance of these differences. STUDY DESIGN/SETTING Single-center retrospective cohort study. PATIENT SAMPLE This study included 296 patients (247 surgical and 49 non-surgical). OUTCOME MEASURES Tibialis anterior (TA) deficit, hand grip (HG), hand intrinsic (HI), bilateral lower extremity motor deficits, bilateral upper extremity motor deficits, tandem gait (TG) abnormalities, straight legged raise (SLR) abnormalities, and extremity sensation (ES) abnormalities. METHODS Included: patients with spine pathologies who received an initial TV and a subsequent OV post-March 2020. Excluded: patients who received telehealth and office visit by two separate providers, providers outside of the spine service, or patients with an initial office visit in the timeframe. The cohort was further analyzed by pathologies. Motor exam results were categorized dichotomously as “full-strength: antigravity” or deficit and other physical exam findings were classified as abnormal and normal. False positives (FP) were classified as abnormalities detected only in TV and false negatives (FN) were categorized as abnormalities detected only in OV.  Relationships between the TV and OV exam findings were established using chi-squared analyses (α=0.05). RESULTS The total cohort's average age is 56.5, BMI=28.6, and 50% female. Among the cohort, 8.9% of lumbar radiculopathy (LR) patients’ TV (w/ 5.1% being FP and 12.7% being FN) recorded a TA deficit, but 16.5% reported deficit in OV (p=0.048). Thus, TV either missed or falsely recorded 17.7% TA deficits. No deficits (0%) were recorded in both HG and HI in MY TV, but 12.5% and 15.6% had reported HG and HI deficits in OV, respectively. For tandem gait (TG), 21.9% MY (w/ 6.3% FP and 15.6% FN) patients’ TV reported an abnormal tandem TG, but in OV, 31.3% (p=0.009) reported abnormalities. For straight-leg raise (SLR), 16.5% LR (w/ 5.1% FP and 7.6% FN) reported abnormal SLR in TV but 13.9% had abnormalities in OV (p CONCLUSIONS TA, TG, SLR, and motor sensation have the highest rates of FP and NP in the spine telehealth examination. There should be a low threshold for an OV in the setting of equivocal testing. During a pandemic, surgeons should rely on the TV history/examination and imaging to make a diagnosis. OV is appropriate in cases in which an accurate TA, TG, SLR, and ES is required. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.