Table 1 Table of included studies (n = 9 cross-sectional studies)

Steele et al. 2012 [32]

Outpatient university-based physical therapy clinic

Final year physiotherapy honours students

Shoulder

Inclusion: adults (> 18 years old), English speaking, adequate level of cognition and communication

Exclusion: poor vision/hearing, concomitant medical conditions (unsafe virtual exam)

22 participants (with 28 reports of shoulder pain)

27.2

30.7 ± 14.2

• Patient interview

• Postural analysis

• Range of motion (shoulder and adjacent joints)

• Self-static muscle tests

• Self-applied orthopaedic tests

• Self-applied neural tests

• Patient interview

• Postural analysis

• Joint palpation

• Range of motion (shoulder and adjacent joints)

• Static muscle tests

• Clinician-applied orthopaedic tests

• Clinician-applied neural tests

Primary clinical diagnosis^a

40.74 (same)^c

59.26 (similar)^d

18.52 (same)^c

40.74 (similar)^d

Systems diagnosis^b

82.1

78.6

Lade et al. 2012 [34]

Physiotherapy clinic

Final year physiotherapy honours students

Elbow

Inclusion: current elbow pain/dysfunction, adults (> 18 years old), English speaking, sufficient cognition/communication

Exclusion: poor vision/hearing (prevent from completing exam)

11

10

38 ± 13

• Patient interview

• Guided observations

• Self-palpation

• Range of motion tests with self-applied over pressure

• Self-resisted static muscle tests

• Self-applied orthopaedic tests

• Self-applied upper limb neural tension tests

• Patient interview

• Observation

• Palpation

• Postural analysis

• Shoulder and neck screening tests

• Joint range of motion tests

• Static muscle tests

• Clinician-applied orthopaedic tests

• Clinician-applied upper limb neural tension tests

Primary clinical diagnosis^a

73

36

Systems diagnosis^b

82

73

Russell et al. 2010 [36]

Physiotherapy clinic

Final year physiotherapy honours students

Ankle

Inclusion: current ankle pain/dysfunction, adults (> 18 years old), English speaking, adequate level of cognition and communication

Exclusion: concomitant medical condition (unsafe to participate)

15

66.7

24.5 ± 10.8

• Patient interview

• Joint range of motion

• Modified self-performed functional, movement, or orthopaedic, and neural tests

• Posture and gait analysis

• Self-palpation

• Self-applied static muscle tests

• Patient interview

• Postural assessment

• Palpation of painful area

• Range of motion

• Clinician-applied muscle, ligament, joint, and neural tissue tests

Primary clinical diagnosis^a

93.3 (same)^c

6.7(similar)^d

53.3(same)^c

40.0(similar)^d

Systems diagnosis^b

93.3

80.0

Russel et al. 2010 [37]

Physiotherapy clinic

Physical therapist (experience not reported)

Lower limb musculoskeletal disorders

Inclusion: lower limb pain not associated with a joint (clinician opinion), adults (> 18 years old), adequate level of cognition and communication

Exclusion: concomitant medical condition (unsafe to participate),

19

73.6

26 ± 13

• Patient interview

• Postural assessment

• Gait analysis

• Functional task analysis

• Observation and self-palpation

• Joint range of motion

• Self-applied manual muscle testing

• Neural system tests

• Self-applied orthopaedic tests

• Patient interview

• Postural assessment

• Gait analysis

• Functional task analysis

• Observation and palpation

• Joint range of motion

• Manual muscle testing

• Neural system tests

• Orthopaedic tests

Primary clinical diagnosis^a

84(same)^c

100(similar)^d

68(same)^c

79(similar)^d

Systems diagnosis^b

100

95.1

k = 0.98 (95% CI; 0.022–0.048)

Richardson et al. 2016 [35]

Physiotherapy clinic

Physiotherapist (experience not reported)

Knee

Inclusion: Adults (> 18 years old), with symptoms of knee pain, adequate level of cognition and communication, ability to independently mobilize

Exclusion: concomitant medical conditions that would prevent them from safely completing a physical exam

18

55.6

23 ± 7

• Patient interview

• Postural examination

• Gait analysis

• Active movement

• Self-palpation

• Self-resisted muscle testing

• Self-applied orthopaedic tests

• Self-applied neurological and neurodynamic movements

• Patient interview

• Postural examination/observation

• Palpation

• Joint range of motion

• Manual muscle tests

• Orthopaedic tests

• Neurological and neurodynamic testing

• Gait and functional task analysis

Primary clinical diagnosis^a

89(same)^c

100 (similar)^d

67(same)^c

89(similar)^d

Systems diagnosis^b

94

94

Cottrell et al. 2018 [33]

Advanced practice physiotherapy screening clinic

Post-graduate qualified Musculoskeletal Physiotherapists employed in an advance-practice role (2–9 years of experience)

Chronic lumbar spine, knee, or shoulder conditions

Inclusion: adults (> 18 years old) with non-urgent or routine assessments for conditions in the lumbar spine, knee, or shoulder, available relevant radiological investigations < 12 months

Exclusion: medical conditions that may preclude a safe examination, hearing or visual impairment, inability to mobilize independently, needed a translator

Total

• Patient interview

• Standard physical exam procedures with modification (self-applied pressure, self-applied orthopaedic tests)

• Patient interview

• Physical examination (pragmatic and remained unchanged from standard clinical practice)

Total

N/A

42

57.1

52.7 ± 14.5

38.1 (same)^c

45.2 (similar)^d

16.7 (different)^e

Lumbar spine

Lumbar spine

14

57

51.6 ± 13.5

42.9 (same)^c

50 (similar)^d

7.1 (different)^e

Knee

Knee

14

43

48.9 ± 14.2

42.9 (same)^c

35.7 (similar)^d

21.4 (different)^e

Shoulder

Shoulder

14

71

57.7 ± 15.5

28.6 (same)^c

50 (similar)^d

21.4 (different)^e

Rabin et al. 2022 [31]

Outpatient shoulder clinic

Board-certified and fellowship-trained orthopaedic surgeons

Inclusion: adults (> 18 years old), unilateral shoulder complaint, access to cellular phone with video call application

Exclusion: lack of good communication skills

47

36

44.6 ± 22.0

• History (over cell phone video call)

• Modified physical examination (visual examination and self-assisted or self-applied tests including range of motion, manual muscle testing, palpation and special tests)

• Demographic information

• History

• Physical examination

• Review of pertinent imaging as per usual practice

85.1% agreement

k = 0.82 (95% CI; 0.69–0.94)

N/A

Wang et al. 2022 [39]

Orthopaedic shoulder clinic

Shoulder surgeon and two independent observers

Inclusion: new patients aged ≥ 18 years presenting with unilateral shoulder complaints

Exclusion: patients with bilateral shoulder complaints, acute fracture, or infection and non–English language speakers

32

47

50.2 ± 16.2

• Blinded history and third-party descriptions of patient imaging

• Modified shoulder examination maneuvers – battery of 40 tests categorized based on motion type, direction, and symptoms (coached by a non-treating team member)

• Blinded history and third-party descriptions of patient imaging

• Standard battery of 40 tests categorized based on motion type, motion direction, and symptom type

Instability KR-20 = 0.56

SLAP/biceps KR-20 = 0.59

Arthritis KR-20 = 1.00

Rotator cuff KR-20 = 0.85

Acromioclavicular joint KR-20 = 0.00

Cervical KR-20 = 1.00

Frozen shoulder KR-20 = 0.93

Other KR-20 = 0.88

N/A

Moreira Dias Jr et al. 2023

Orthopaedic outpatient

17 medical professionals with 3 different degrees of expertise (orthopaedic residents, orthopaedists who were not specialists in spine surgery, orthopaedists who specialized in spine surgery)

Inclusion: adults with low back pain lasting 6 weeks or more who were awaiting an appointment for their first orthopedic care visit at a local referral center

Exclusion: individuals with suspected emergency situations, symptoms other than low back pain, or those without digital resources

126

66.4

47.8 ± 13.1

• Digital questionnaire completed by the participants

• Adapted physical examination

• Digital questionnaire completed by the participants

• Traditional physical examination

79.5% agreement

k = 0.585, P < 0.001

N/A