Comparing In-Person, Standard Telehealth, and Remote Musculoskeletal Examination with a Novel Augmented Reality Exercise Game System: A Pilot Study (Preprint)

Abstract

Current telemedicine technology is not optimized for conducting physical examinations. The Virtual Remote Tele-Physical Examination (VIRTEPEX) system, a novel proprietary technology platform which uses a Microsoft Kinect-based augmented reality game system to track motion and estimate force, has potential to assist with conducting asynchronous, remote musculoskeletal examination.

This pilot study evaluates the feasibility of the VIRTEPEX system for supplementing telehealth musculoskeletal strength assessments.

In this cross-sectional pilot study, 12 study participants with upper extremity pain and/or weakness underwent in-person, telehealth, VIRTEPEX, and composite (telehealth plus VIRTEPEX) strength evaluations for four upper extremity movements. Evaluators were blinded to one another’s evaluations. The primary outcome was feasibility, as determined by participant study recruitment, completion, and safety. The secondary outcome was preliminary assessment of inter-rater agreements between in-person, telehealth, and VIRTEPEX strength assessments, plus kappa statistical calculations.

This pilot study had an 80% recruitment rate, 100% completion rate, and 0 adverse events. In-person and telehealth evaluations had highest overall agreement (85.71%), greater than the agreements between in-person and VIRTEPEX (62.50%), in-person and composite (75%), and telehealth and VIRTEPEX evaluations (62.50%). However, for shoulder flexion, agreement between in-person and VIRTEPEX (78.57%, κ=0.571, 95% CI of 0.183 to 0.960), and also in-person and composite evaluations (78.57%, κ=0.571, 95% CI of 0.183 to 0.960), was greater than that for in-person and telehealth (71.43%, κ=0.429, 95% CI of -0.025 to 0.882).

This work demonstrates the feasibility of asynchronous VIRTEPEX examination and supports the potential for VIRTEPEX to supplement and add value to standard telehealth platforms. Further study, with additional development of VIRTEPEX and larger sample size for adequate power, is warranted.