Comparative reliability of online assessment of elbow and wrist function in civilian and military populations

Introduction This study aimed to evaluate the reliability of online assessment tools for elbow and wrist function in civilian and military patients. In addition, functional outcomes were compared between cohorts to identify potential differences related to injury context and patient characteristics. Methods Two distinct cohorts participated: (1) military patients (MP), including 25 males from Ukraine (mean age 37.83 ± 6.97 years) with combat-related upper limb injuries, and (2) civilian patients (CP), comprising 28 males from Lithuania (mean age 39.33 ± 8.85 years) with noncombatant injuries. Four experienced physiotherapists (two per country), each with over 10 years of experience in musculoskeletal assessment, conducted evaluations using the Modified Mayo Wrist Score (MMWS) and the Mayo Elbow Performance Score (MEPS) both on-site and online. Results The intraclass correlation coefficients (ICCs) and kappa values exceeded 0.90 across both groups, indicating excellent reliability of online functional assessment. Significant differences were observed between the CP and MP groups in MEPS pain domain scores ( P = 0.020) and MMWS domains of range of motion and grip strength ( P < 0.001). A strong, statistically significant correlation was found between elbow and wrist function in the MP group (on-site r s = 0.848; online r s = 0.880; P < 0.001), whereas no significant correlation was observed in the CP group. Discussion The high inter-rater reliability supports the clinical use of MEPS and MMWS in online formats. Functional differences between cohorts highlight the impact of injury mechanism and rehabilitation context, emphasizing the importance of tailored assessment and intervention strategies in telerehabilitation.