{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T08:41:08Z","timestamp":1794040868753,"version":"4.8.0"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Access to care for patients with musculoskeletal disorders (MSKDs) remains a significant challenge. Telehealth has emerged as a promising solution to improve access to care. However, conducting initial evaluations of MSKDs remotely raises concerns about patient safety and clinical efficacy due to the necessary adaptations required for a clinical examination and the challenges of obtaining an accurate and reliable diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We aim to explore the use of telehealth for the initial evaluation of MSKDs in the province of Quebec, Canada. Through semistructured interviews with selected patients, health care providers, and other key stakeholders involved in telehealth, this study aims to provide a comprehensive and detailed understanding of its application, benefits, and challenges.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Semistructured interviews were conducted in the province of Quebec with patients, clinicians, telehealth software specialists, and professional bodies\u2019 representatives. Five tailored interview guides were developed using the Consolidated Framework of Implementation Research and the Framework of Mathieu-Fritz and Esterle for the study of telehealth interventions. The themes explored included participants\u2019 prior experiences with telehealth, perceived strengths and limitations of telehealth, particularly regarding the initial evaluation and diagnosis of new patients, and the current global environment of telehealth use. All interviews were transcribed verbatim, and a reflexive thematic analysis was performed using the Mathieu-Fritz Framework.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Thirty-eight participants, including patients (n=11), health care providers (family physicians and musculoskeletal medical specialists: n=11; and physiotherapy professionals: n=10), telehealth software specialists (n=2), and representatives from professional bodies (n=4), shared their perspectives on telehealth for the initial evaluation of MSKDs. Five key themes emerged: (1) several participants viewed telehealth, including remote evaluations, as a solution to improve access to care; (2) patients and health care providers reported that a remote evaluation was more appropriate for simpler MSKD presentations; (3) some health care providers expressed concerns about the potential for an increase in diagnostic errors and the challenges of performing all usual components of a standard MSKD physical examination remotely; (4) patients expressed doubts about their ability to effectively perform certain tasks or tests on themselves; and (5) broader challenges were also highlighted by all participants, such as the impact on the patient-clinician relationship, access to appropriate hardware, digital literacy, and confidentiality concerns.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Telehealth is seen as a valuable solution to improve access to care for patients with MSKDs, especially for simpler cases or urgent needs. However, remote physical examination poses challenges associated with concerns about diagnostic accuracy and limited remote physical examination procedures and components. Effective implementation will likely require more evidence-based guidelines, provider training on remote techniques and strategies to maintain patient-provider relationships. Addressing access to technology, digital literacy, and privacy concerns is also essential to ensure equitable adoption and to optimize telehealth in musculoskeletal care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/72901","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T14:45:06Z","timestamp":1747233906000},"page":"e72901-e72901","source":"Crossref","is-referenced-by-count":3,"title":["Telehealth for the Initial Evaluation of Musculoskeletal Disorders: Qualitative Study of Patients, Health Care Providers, and Key Stakeholders in the Province of Quebec in Canada"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1599-0224","authenticated-orcid":false,"given":"Rapha\u00ebl","family":"Vincent","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9824-6368","authenticated-orcid":false,"given":"Pauline","family":"Lemersre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9366-453X","authenticated-orcid":false,"given":"Genevi\u00e8ve","family":"Ferland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6924-3332","authenticated-orcid":false,"given":"Annie","family":"B\u00e9langer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6622-0864","authenticated-orcid":false,"given":"Audrey-Anne","family":"Cormier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8608-9661","authenticated-orcid":false,"given":"Kadija","family":"Perreault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2853-9940","authenticated-orcid":false,"given":"Jean S\u00e9bastien","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-0802","authenticated-orcid":false,"given":"Nicolas","family":"Pinsault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6872-6607","authenticated-orcid":false,"given":"Dahlia","family":"Kairy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0290-7031","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Desmeules","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"issue":"10267","key":"R1","doi-asserted-by":"publisher","first-page":"2006","DOI":"10.1016\/S0140-6736(20)32340-0","article-title":"Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Cieza","journal-title":"Lancet"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1136\/bjsports-2018-099878","article-title":"What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review","volume":"54","author":"Lin","journal-title":"Br J Sports Med"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1080\/09638288.2019.1639222","article-title":"Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review","volume":"43","author":"Deslauriers","journal-title":"Disabil Rehabil"},{"key":"R4","unstructured":"Moir M Barua B . Waiting your turn: wait times for health care in Canada. Fraser Institute; 2021. URL: https:\/\/www.fraserinstitute.org\/sites\/default\/files\/waiting-your-turn-2021.pdf [Accessed 27-06-2025]"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3669-6","article-title":"Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review","volume":"18","author":"Lewis","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"56","DOI":"10.2519\/jospt.2016.6138","article-title":"Timing of physical therapy initiation for nonsurgical management of musculoskeletal disorders and effects on patient outcomes: a systematic review","volume":"46","author":"Ojha","journal-title":"J Orthop Sports Phys Ther"},{"key":"R7","unstructured":"World Confederation for Physical Therapy. Report of the WCPT\/INPTRA digital physical therapy practice task force. World Physiotherapy; 2020. URL: https:\/\/world.physio\/sites\/default\/files\/2021-06\/digital-practice-report-2021-FINAL.pdf [Accessed 27-06-2025]"},{"issue":"1-2","key":"R8","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1038\/pr.2015.192","article-title":"Addressing health disparities in rural communities using telehealth","volume":"79","author":"Marcin","journal-title":"Pediatr Res"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1071\/AH09794","article-title":"The reported benefits of telehealth for rural Australians","volume":"34","author":"Moffatt","journal-title":"Aust Health Rev"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.937207","article-title":"Telemedicine solutions for clinical care delivery during COVID-19 pandemic: a scoping review","volume":"10","author":"Ganjali","journal-title":"Front Public Health"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1177\/1357633X20963935","article-title":"A telemedicine strategy to reduce waiting lists and time to specialist care: a retrospective cohort study","volume":"29","author":"Pfeil","journal-title":"J Telemed Telecare"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzae045","article-title":"Telerehabilitation in physical therapist practice: a clinical practice guideline from the American physical therapy association","volume":"104","author":"Lee","journal-title":"Phys Ther"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1177\/0269215516645148","article-title":"Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis","volume":"31","author":"Cottrell","journal-title":"Clin Rehabil"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzab075","article-title":"Effectiveness of telerehabilitation in physical therapist practice: an umbrella and mapping review with meta-meta-analysis","volume":"101","author":"Suso-Mart\u00ed","journal-title":"Phys Ther"},{"issue":"6","key":"R15","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1177\/02692155221083496","article-title":"Effectiveness of physical therapy given by telerehabilitation on pain and disability of individuals with shoulder pain: a systematic review","volume":"36","author":"Gava","journal-title":"Clin Rehabil"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/10833196.2023.2195214","article-title":"Telerehabilitation versus face-to-face rehabilitation in the management of musculoskeletal conditions: a systematic review and meta-analysis","volume":"28","author":"Krzyzaniak","journal-title":"Phys Ther Rev"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.11.04072","article-title":"The utility of physiotherapy assessments delivered by telehealth: a systematic review","volume":"11","author":"Zischke","journal-title":"J Glob Health"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/52964","article-title":"Investigating the use of telemedicine by health care providers to diagnose and manage patients with musculoskeletal disorders: systematic review and meta-analysis","volume":"26","author":"Vincent","journal-title":"J Med Internet Res"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1177\/1357633X16642369","article-title":"Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review","volume":"23","author":"Mani","journal-title":"J Telemed Telecare"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/j.jht.2023.06.004","article-title":"A description of the barriers, facilitators, and experiences of hand therapists in providing remote (tele) rehabilitation: an interpretive description approach","volume":"36","author":"Farzad","journal-title":"J Hand Ther"},{"issue":"3","key":"R21","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1002\/msc.1622","article-title":"The acceptability of two remote monitoring modalities for patients waiting for services in a physiotherapy outpatient clinic","volume":"20","author":"Renard","journal-title":"Musculoskeletal Care"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2021.102340","article-title":"\u201cIt\u2019s not hands-on therapy, so it\u2019s very limited\u201d: telehealth use and views among allied health clinicians during the coronavirus pandemic","volume":"52","author":"Malliaras","journal-title":"Musculoskelet Sci Pract"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2024.102930","article-title":"Musculoskeletal physiotherapists\u2019 experiences of using remote consultations during the COVID-19 pandemic: a qualitative study","volume":"72","author":"Cook","journal-title":"Musculoskelet Sci Pract"},{"issue":"686","key":"R24","doi-asserted-by":"publisher","first-page":"e586","DOI":"10.3399\/bjgp19X704141","article-title":"Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care","volume":"69","author":"Donaghy","journal-title":"Br J Gen Pract"},{"issue":"5","key":"R25","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.15084","article-title":"Remote musculoskeletal consultations: a survey of general practitioner registrars\u2019 level of confidence, acceptability, and management","volume":"13","author":"Sahni","journal-title":"Cureus"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"8","DOI":"10.2519\/jospt.2021.9902","article-title":"Connecting at the webside: rapid telehealth implementation for musculoskeletal clinicians","volume":"51","author":"Rethorn","journal-title":"J Orthop Sports Phys Ther"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-019-0226-y","article-title":"It\u2019s not just FaceTime: core competencies for the medical virtualist","volume":"12","author":"Sharma","journal-title":"Int J Emerg Med"},{"issue":"6","key":"R28","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1177\/2374373520968975","article-title":"Enhancing your webside manner: optimizing opportunities for relationship-centered care in virtual visits","volume":"7","author":"Modic","journal-title":"J Patient Exp"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.3917\/rfs.542.0303","article-title":"Changes in professional practices during medical teleconsultations. interprofessional cooperation and the delegation of tasks","volume":"54","author":"Mathieu-Fritz","journal-title":"Rev Fr Sociologie"},{"key":"R30","doi-asserted-by":"crossref","unstructured":"Willig C Rogers WS . The SAGE Handbook of Qualitative Research in Psychology. SAGE Publications; 2017.","DOI":"10.4135\/9781526405555"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","journal-title":"Int J Qual Health Care"},{"key":"R32","unstructured":"The two physiotherapy professions. Ordre professionnel de la physioth\u00e9rapie du Qu\u00e9bec. URL: https:\/\/oppq.qc.ca\/en\/physiotherapy\/the-two-professions\/ [Accessed 27-06-2025]"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-023-07100-x","article-title":"Advanced practice physiotherapy care in emergency departments for patients with musculoskeletal disorders: a pragmatic cluster randomized controlled trial and cost analysis","volume":"24","author":"Matifat","journal-title":"Trials"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","journal-title":"Implement Sci"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","journal-title":"Qual Health Res"},{"issue":"5","key":"R36","doi-asserted-by":"publisher","first-page":"607","DOI":"10.4300\/JGME-D-21-00752.1","article-title":"Beyond the guise of saturation: rigor and qualitative interview data","volume":"13","author":"LaDonna","journal-title":"J Grad Med Educ"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"key":"R38","unstructured":"Trupia DV Mathieu-Fritz A Klein N et al. \u00c9tude Sociologique sur l\u2019Accompagnement \u00e0 l\u2019Autonomie en Sant\u00e9 Des Patients Adultes Atteints de Mucoviscidose \u00e0 l\u2019Aide des Nouvelles Technologies et en Partenariat Avec les Professionnels de Sant\u00e9 Lib\u00e9raux (MUCO-PRO) [Book in French]. LATTS - ENPC; 2023."},{"issue":"3","key":"R39","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1370\/afm.2095","article-title":"Patient perceptions of telehealth primary care video visits","volume":"15","author":"Powell","journal-title":"Ann Fam Med"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1016\/j.pecinn.2023.100171","article-title":"Patients\u2019 perspectives on digital health tools","volume":"2","author":"Madanian","journal-title":"PEC Innov"},{"issue":"11","key":"R41","doi-asserted-by":"publisher","DOI":"10.2196\/25159","article-title":"The sociological perspective of users\u2019 invisible work: a qualitative research framework for studying digital health innovations integration","volume":"23","author":"Trupia","journal-title":"J Med Internet Res"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.47176\/mjiri.36.157","article-title":"Exploring barriers to implementing telerehabilitation from experiences of managers, policymakers, and providers of rehabilitation services in Iran: a qualitative study","volume":"36","author":"Rabanifar","journal-title":"Med J Islam Repub Iran"},{"issue":"1","key":"R43","doi-asserted-by":"publisher","DOI":"10.1002\/msc.1840","article-title":"Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists","volume":"22","author":"Ezzat","journal-title":"Musculoskeletal Care"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/44591","article-title":"Clinicians\u2019 experiences of implementing a Telerehabilitation Toolkit during the COVID-19 pandemic: qualitative descriptive study","volume":"10","author":"Munce","journal-title":"JMIR Rehabil Assist Technol"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2025\/1\/e72901","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:03:21Z","timestamp":1782842601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2025\/1\/e72901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":44,"URL":"https:\/\/doi.org\/10.2196\/72901","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,24]]},"article-number":"v27i10267e72901"}}