Alecia K. Daunter

Background Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. Objective To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. Design Randomized controlled trial. Setting Mock telehealth encounter. Participants A total of 30 volunteer dyads of children aged 4–17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. Intervention The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. Main Outcome Measures Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. Results The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group ( p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 ( p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 ( p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers ( p = .255), total time ( p = .061) or total verbal prompts ( p = .095). However, group allocation significantly predicted total verbal prompts ( p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as ‘definitely helpful’. Conclusion Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.