Strength is another important component of a physiotherapy assessment. However, muscle strength can be difficult to quantify when the therapist is not in-person. This page provides some alternative options on ways to assess strength when using telehealth.


In a telehealth session strength can be evaluated through the observation of functional tests or movements, as well as through modified testing of individual muscles. Some things to remember when assessing strength via telehealth:

  • Be sure to ask the patient what is limiting their movement (e.g. pain, fatigue, stiffness)
  • Clearly document how you assessed strength to be able to repeat the test at another time.
  • Test both sides for comparison.

Options for evaluating strength via telehealth:

Patient applies resistanceEasy to complete.
Minimal time requirements.
Cannot be quantified.
Lacks accuracy.
Use if accuracy is not required as changes are not expected or gross changes are expected.
Use weights (light, moderate, heavy)Quantifiable.
Easy to complete if the equipment is available.
Access to weights that can be attached.
Increased time to attach weights.
Use if accuracy is required to measure increased strength/endurance.
Use elastic resistance bands (colour ranges)Can be set prior to the assessment.
Easy to complete if patient familiar with using elastic bands.
Cannot be quantified.
Lacks accuracy.
Timing, if patient is unfamiliar with elastic resistance bands.
Patient needs experience with using elastic resistance bands for good performance.
Functional taskQuantifiable.
Easy to complete.
No equipment required.
For lower extremity tested in weight bearing.
Increased accuracy to measure strength/endurance.

The following table provides an example of how to score strength testing via telehealth. “V” means that the measurement was done virtually via telehealth.

Modified Virtual Muscle Grading

Standard gradeMovementModified virtual grade (V)Additional Notes
0No muscle contraction observed<3-VIf a muscle is <3 is may not be feasible or reliable to make further distinctions virtually (e.g. to determine difference between 0 and 1).
1Evidence of slight muscle contractility without joint motion<3-VAlways ask patient what is preventing them from moving (i.e. pain, fatigue, stiffness)
2Complete range of motion with gravity eliminated<3-VMay consider asking patient to assist with active assisted range of motion if <3-V.
3Complete range of motion against gravity (no additional resistance)3-V
4Complete range of motion against gravity with some resistance4-VShould be evidence of weakness compared to contralateral side (i.e. compensation, trembling, patient perception of a difference R to L with self-resistance). Be sure to document type/amount of resistance
5Complete range of motion against gravity with full resistance or functional range and functional resistance5-VNormal resistance against gravity with resistance, comparable to contralateral side. Patient can indicate if represents normal functional ability.

Adapted from: Inter-professional Spine Assessment and Education Clinics (ISAEC Operations),
Low Back Rapid Access Clinic: Virtual Assessment and Education Toolkit. Toronto, ON: 2020 


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