Not ready for prime time: No currently-available digital health tools that can triage musculoskeletal conditions have sufficient evidence to support use in primary, urgent, and emergency care settings. A scoping review (Preprint)

BACKGROUND Musculoskeletal conditions are one of the largest contributors to the global burden of disease. Digital health tools can support triage of musculoskeletal conditions and help patients and clinicians make decisions about access to care. The digital health research field is growing rapidly, and a summary of the available digital tools for triaging musculoskeletal conditions is needed. Effective and safe digital triage tools for musculoskeletal conditions could support patients in making informed care decisions, aid clinicians and patients in navigating care, and may contribute to reducing ED overcrowding and healthcare costs. OBJECTIVE To identify and describe digital health tools for use by adults to triage musculoskeletal conditions in adults across primary, urgent, or emergency care settings. METHODS Our scoping review was conducted in accordance with the Johanna Briggs Institute recommendations for scoping reviews, and was guided by Arksey & O’Malley’s framework, with Levac’s et al additions. Systematic searches in MEDLINE (OVID), CINAHL (EBSCO), PsycINFO (EBSCO), Embase (OVID), Cochrane Library, Web of Science Core Collection, OpenGrey, GoogleScholar, arXiv.org, medRxiv.org and an extensive grey literature search were conducted with a librarian scientist. Two reviewer pairs independently screened abstracts and full-text articles. Included studies had to identify a digital health tool that could triage musculoskeletal conditions in adults at a first point-of-contact health care setting (ie, primary, urgent, or emergency care settings), and report primary data. Relevant data were extracted in duplicate, and results were summarized descriptively. RESULTS The search yielded 5017 records, and we screened 165 full text articles. Twenty-eight studies (n=36,928 patients) met the inclusion criteria. The most common musculoskeletal conditions reported across studies were rheumatoid and inflammatory arthritis (n=8, 29%). Fifteen (55%) studies reported on symptom checkers, 11 (38%) studies on triage/diagnosis tools, and 2 (7%) studies were diagnostic predictor tools. Thirteen unique digital health tools were identified across the 28 studies. Two tools were purposely built for triaging musculoskeletal conditions but were not publicly available outside the UK Health Service. Most tools were generic tools designed to screen for general health problems, including musculoskeletal conditions. The most common approach to evaluating performance (eg, accuracy) of the tools was to compare the concordance of the tool to a clinician diagnosis or triage recommendation. Sensitivity and specificity ranged from 43%-91% and 23%-72%, respectively. Reported accuracy of included tools ranged from 33% to 98%. CONCLUSIONS Musculoskeletal conditions remain a blind spot for people designing, implementing, and evaluating digital health for triage: few tools were specifically designed for musculoskeletal conditions, and most existing tools performed poorly when applied to musculoskeletal populations. The evidence base is weak supporting accuracy of digital health to triaging and diagnosing musculoskeletal conditions, and tool performance was inconsistent and lack transparency. We recommend a focus on designing digital tools specifically for musculoskeletal conditions, and urge developers and evaluators to use transparent, standardized processes that prioritize tool safety, clinical value, and trustworthiness before integrating these tools into care pathways. CLINICALTRIAL n/a