Table 4.

Concerns of practitioners regarding the validity and reliability of remote physical assessments.

Theme	Description	Exemplar quote
Lack of confidence in measures used remotely	Practitioners expressed distrust and skepticism in the accuracy and reliability of the measures they used, as they felt they were not designed to be used remotely. This led to uncertainty about the effectiveness of interventions. Practitioners described taking outcome measures with a “spoonful of salt” and used them as a general indication of health, rather than to evaluate change. This theme was the most frequent concern out of all responses.	“We are having to use observations which have unknown reliability and validity when used remotely.” (Physiotherapist, Musculoskeletal)
Physical examination restrictions	Physical examinations were reported as being considerably restricted when working remotely. Examples of problems were a limited view of the patient due to the camera angle, not feeling the movements of the patient, and difficulty gaining a valid assessment of mobility. This theme was the second most frequent concern.	“It’s easy to miss things over video. You can’t always see all the movement.” (Occupational Therapist, Generic)
Patient safety concerns	Practitioners were concerned for the patient’s safety when engaging in physical assessments. As they were not physically present, they felt that they were not in control of the patient’s environment, and therefore unable to minimize the risk of falls or other safety incidents.	“Safety can be a real concern. If the person is at risk of falls then you need a carer by them or otherwise I don't undertake the test.” (Physiotherapist, Neurology)
Communication issues	Communication issues between the patient and practitioner related to information clarity and ensuring the patient understood instructions during assessments. Practitioners expressed that the lack of nonverbal cues and body language could hinder rapport building. Some concerns also revolved around distractions in the patient’s home environment.	“There is less rapport [online] so I feel that the client is less likely to reliably report how they are managing [their condition].” (Occupational Therapist, Neurology)
Technology issues	Practitioners reported that technical issues including hardware and internet connections impacted on their ability to carry out physical assessments. Poor quality of video and time lags reduced visual acuity and ability to discern subtle changes in movement.	“It is sometimes difficult to visually pick up all aspects due to poor internet connection.” (Physiotherapist, Pediatrics)