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Chahal S, Siddiqui R, Puskas L, Littlefield S, Naeem L, Fanti C, Cullinan C, Droll K, Puskas D, Marion TE. Impact of a Remote Patient Monitoring Platform on Outcomes Following a Total Hip or Knee Arthroplasty. Arthroplast Today 2024; 27:101415. [PMID: 38912097 PMCID: PMC11190474 DOI: 10.1016/j.artd.2024.101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background The coronavirus pandemic highlighted the need for remote patient monitoring to deliver and provide access to patient care and education. A mobile-based app providing interactive tools for patient education and monitoring was piloted at Thunder Bay Regional Health Sciences Centre (TBRHSC) in November 2020. We aimed to examine the platform's impact on postoperative length of stay, hospital readmissions, and emergency department (ED) visits 60 days postsurgery in total hip and knee arthroplasty patients in Northwestern Ontario. Methods Data were assessed from patients undergoing primary total hip or knee arthroplasties at TBRHSC from March 1, 2020, to February 28, 2022. Patients were divided into 2 cohorts based on enrollment with the mobile-based app (SeamlessMD). Statistical differences in outcomes were determined using Mann-Whitney or χ2 tests. An odds ratio was calculated for ED visits. Results Patients enrolled in the mobile-based app had statistically lower length of stay (U = 7779.0, P < .001) and fewer ED visits (χ2 (1,212) = 5.570, P = .018) than patients not enrolled in the program. Patients not enrolled had 2.31 times greater odds of visiting the ED postsurgery (odds ratio = 0.432, 95% confidence interval = 0.213-0.877, P = .022). There were no statistical differences found in readmission rates. Conclusions The implementation of the mobile-based app at TBRHSC showed its potential value as a tool to reduce costs in the healthcare system and improve patient outcomes. Consequentially, more formal studies are required to elucidate the magnitude of this effect.
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Affiliation(s)
- Simrun Chahal
- Clinical Research Services Department, Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Rabail Siddiqui
- Clinical Research Services Department, Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Liam Puskas
- Lakehead University, Thunder Bay, ON, Canada
| | - Shalyn Littlefield
- Clinical Research Services Department, Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Lahama Naeem
- Clinical Research Services Department, Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Caroline Fanti
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Claude Cullinan
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - Kurt Droll
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - David Puskas
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
| | - Travis E. Marion
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
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2
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Sniderman J, Monarrez R, Drew J, Abdeen A. Mobile Application Use and Patient Engagement in Total Hip and Knee Arthroplasty. JBJS Rev 2024; 12:01874474-202402000-00003. [PMID: 38394327 DOI: 10.2106/jbjs.rvw.23.00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
» Mobile applications (MAs) are widely available for use during the perioperative period and are associated with increased adherence to rehabilitation plans, increased satisfaction with care, and considerable cost savings when used appropriately.» MAs offer surgeons and health care stakeholders the ability to collect clinical data and quality metrics that are important to value-based reimbursement models and clinical research.» Patients are willing to use wearable technology to assist with data collection as part of MAs but prefer it to be comfortable, easy to apply, and discreet.» Smart implants have been developed as the next step in MA use and data collection, but concerns exist pertaining to patient privacy and cost.» The ongoing challenge of MA standardization, validation, equity, and cost has persisted as concerns regarding widespread use.
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Affiliation(s)
- Jhase Sniderman
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
- Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Monarrez
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital, Baltimore, Maryland
| | - Jacob Drew
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
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Wu KA, Anastasio AT, Kim JK, Choudhury A, Adams SB. Evaluating the impact of work from home policies on Google search Trends related to ankle surgery during the COVID-19 pandemic. Work 2024:WOR230621. [PMID: 38306085 DOI: 10.3233/wor-230621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic caused notable shifts in healthcare behavior, influenced by remote work policies. This study examines the impact of Work from Home (WFH) policies on public interest in ankle-related orthopaedic surgeries, utilizing Google search trends. Understanding these trends is crucial for healthcare providers, enabling them to adapt services and communication to evolving patient needs during challenging times. OBJECTIVE To comprehend variations in search volume and trends for ankle-related queries due to WFH policies during the COVID-19 pandemic. METHODS Ankle-related terms accessible to laypersons were analyzed using Google Trends data from March 2018 to March 2022 in the United States. Data were divided into pre-pandemic (March 2018-March 2020) and post-pandemic (March 2020-March 2022) periods. Weekly search interest data for 20 terms were analyzed using a Mann-Whitney U test. The study aimed to identify significant changes in search interest, providing insights into public information-seeking behavior concerning ankle surgeries. RESULTS Among the 20 terms analyzed, 11 exhibited significant changes. Ankle arthritis and ankle bursitis showed increased interest, suggesting heightened concern during the pandemic. Conversely, post-pandemic interest decreased for terms 9 terms, including ankle pain and ankle tendonitis, indicating reduced worry. Moderate declines were noted for ankle gout, Achilles tendonitis, and heel bursitis, reflecting shifting patient priorities. Some terms, including ankle fracture and ankle arthroplasty, showed stable information-seeking behavior despite the pandemic. CONCLUSIONS The study underscores the nuanced impact of WFH policies on public interest in ankle-related orthopaedic surgeries. Varied search trends highlight changing patient concerns. Healthcare providers can use these insights to tailor services effectively, meeting evolving patient needs and enhancing communication strategies.
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Affiliation(s)
- Kevin A Wu
- Duke University School of Medicine, Durham, NC, USA
- Duke University Department of Orthopaedic Surgery, Durham, NC, USA
| | | | - Joshua K Kim
- Duke University School of Medicine, Durham, NC, USA
| | | | - Samuel B Adams
- Duke University Department of Orthopaedic Surgery, Durham, NC, USA
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Youssef Y, De Wet D, Back DA, Scherer J. Digitalization in orthopaedics: a narrative review. Front Surg 2024; 10:1325423. [PMID: 38274350 PMCID: PMC10808497 DOI: 10.3389/fsurg.2023.1325423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Advances in technology and digital tools like the Internet of Things (IoT), artificial intelligence (AI), and sensors are shaping the field of orthopaedic surgery on all levels, from patient care to research and facilitation of logistic processes. Especially the COVID-19 pandemic, with the associated contact restrictions was an accelerator for the development and introduction of telemedical applications and digital alternatives to classical in-person patient care. Digital applications already used in orthopaedic surgery include telemedical support, online video consultations, monitoring of patients using wearables, smart devices, surgical navigation, robotic-assisted surgery, and applications of artificial intelligence in forms of medical image processing, three-dimensional (3D)-modelling, and simulations. In addition to that immersive technologies like virtual, augmented, and mixed reality are increasingly used in training but also rehabilitative and surgical settings. Digital advances can therefore increase the accessibility, efficiency and capabilities of orthopaedic services and facilitate more data-driven, personalized patient care, strengthening the self-responsibility of patients and supporting interdisciplinary healthcare providers to offer for the optimal care for their patients.
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Affiliation(s)
- Yasmin Youssef
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Deana De Wet
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
| | - David A. Back
- Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Julian Scherer
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
- Department of Traumatology, University Hospital of Zurich, Zurich, Switzerland
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5
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Markus DH, Colasanti CA, Kaplan DJ, Manjunath AK, Alaia MJ, Strauss EJ, Jazrawi LM, Campbell KA. High Rate of Patient Satisfaction with Either Telemedicine or Traditional Office-Based Follow-Up Visit After Arthroscopic Shoulder Surgery. Telemed J E Health 2024; 30:134-140. [PMID: 37318834 DOI: 10.1089/tmj.2022.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The purpose of this study was to determine if any differences exist in patient satisfaction with office-based visits versus telemedicine visits following arthroscopic shoulder surgery. Methods: Patients undergoing shoulder arthroscopy were prospectively enrolled for 1 year. Patient demographic and clinical data (including complication events) and second postoperative visit satisfaction data were recorded and analyzed for statistical significance. Results: Ninety-six (n = 96) patients met inclusion criteria. Fifty-four patients (56.3%) participated in a traditional in-person office visit, and 42 participated in a video visit (43.8%). No significant differences were found between office and video appointments in terms of overall care satisfaction (9.46 ± 0.9 vs. 9.55 ± 1.0, p = 0.67). Females were significantly less satisfied with their second postoperative visit compared with males (8.3 ± 2.3 vs. 9.3 ± 1.5, p = 0.035). Significantly more females would also have preferred a traditional in person office visit compared with males (91% vs. 67%, p = 0.009). Video appointment patients spent significantly more time with their surgeon than office visit patients (57.64 mean rank vs. 41.39 mean rank, p = 0.003). Discussion: Video visit patients required significantly less time overall for their visit and spent significantly more time with their surgeon, although did not demonstrate differences in satisfaction.
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Affiliation(s)
- Danielle H Markus
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Christopher A Colasanti
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Daniel J Kaplan
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Amit K Manjunath
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Michael J Alaia
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Eric J Strauss
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Orthopedic Surgery Department, NYU Langone Health, New York, New York, USA
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Mavrodontis II, Trikoupis IG, Kontogeorgakos VA, Savvidou OD, Papagelopoulos PJ. Point-of-Care Orthopedic Oncology Device Development. Curr Oncol 2023; 31:211-228. [PMID: 38248099 PMCID: PMC10814108 DOI: 10.3390/curroncol31010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The triad of 3D design, 3D printing, and xReality technologies is explored and exploited to collaboratively realize patient-specific products in a timely manner with an emphasis on designs with meta-(bio)materials. METHODS A case study on pelvic reconstruction after oncological resection (osteosarcoma) was selected and conducted to evaluate the applicability and performance of an inter-epistemic workflow and the feasibility and potential of 3D technologies for modeling, optimizing, and materializing individualized orthopedic devices at the point of care (PoC). RESULTS Image-based diagnosis and treatment at the PoC can be readily deployed to develop orthopedic devices for pre-operative planning, training, intra-operative navigation, and bone substitution. CONCLUSIONS Inter-epistemic symbiosis between orthopedic surgeons and (bio)mechanical engineers at the PoC, fostered by appropriate quality management systems and end-to-end workflows under suitable scientifically amalgamated synergies, could maximize the potential benefits. However, increased awareness is recommended to explore and exploit the full potential of 3D technologies at the PoC to deliver medical devices with greater customization, innovation in design, cost-effectiveness, and high quality.
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Affiliation(s)
- Ioannis I. Mavrodontis
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.G.T.); (V.A.K.); (O.D.S.); (P.J.P.)
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7
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Digital Orthopedics: The Future Developments of Orthopedic Surgery. J Pers Med 2023; 13:jpm13020292. [PMID: 36836526 PMCID: PMC9961276 DOI: 10.3390/jpm13020292] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Digital medicine is a new type of medical treatment that applies modern digital information technologies to entire medical procedures [...].
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8
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Pearson J, Ayers D, Zheng H. The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature. JMIR Perioper Med 2023; 6:e39396. [PMID: 36633891 PMCID: PMC9880809 DOI: 10.2196/39396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR. OBJECTIVE We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR. METHODS We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures. RESULTS A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback. CONCLUSIONS These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation.
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Affiliation(s)
| | - David Ayers
- Department of Orthopedics and Physical Rehabilitation, UMass Chan Medical School, Worcester, MA, United States
| | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, UMass Chan Medical School, Worcester, MA, United States
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9
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Yedulla NR, Hester JD, Patel MM, Cross AG, Peterson EL, Makhni EC. Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit: Results from a Double-Blinded, Prospective, Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:20-26. [PMID: 36598473 DOI: 10.2106/jbjs.21.00506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are metrics that assess physical health, mental health, pain, and satisfaction. However, PROM collection in orthopaedic clinics presents numerous logistical and financial challenges. These challenges are reduced when PROMs are completed before clinic encounters, relieving the workflow constraints of in-office PROM collection. The purpose of this study was to determine the efficacy of 3 different methods with respect to pre-visit electronic PROM completion. METHODS Consecutive adult orthopaedic patients with no previous PROM participation were enrolled. Patients who registered with the electronic medical record (EMR) patient portal (MyChart) and with active e-mail addresses were randomly assigned to 1 of 3 arms: control (no pre-visit messages), MyChart (EMR patient portal pre-visit messages), and e-mail (e-mail pre-visit messages). The primary outcome measure was pre-visit PROM completion rates in orthopaedic patients, and the secondary outcome measures were time to pre-visit PROM form completion and PROM form completion rates according to patient demographic characteristics. By default, the Patient-Reported Outcomes Measurement Information System (PROMIS) forms were available for completion through the portal by 7 days before scheduled visits. Pre-visit messages were sent 7 days prior to the scheduled visit except in the control group, with reminders sent 3 days prior if still not completed. The patients in each arm who completed all assigned forms were labeled as having total PROM completion, and those who completed at least 1 completed form were considered as having partial PROM completion. Multivariable logistic regression models were used to assess differences in PROM completion rates between study arms. Kruskal-Wallis tests were performed to compare the date of the form completion. RESULTS A total of 291 patients were included. The pre-visit total completion rates for assigned PROMs were higher in the MyChart arm (49% of 97 patients; p = 0.005) and the e-mail arm (52% of 100 patients; p = 0.002) in comparison with the control arm (30% of 94 patients). Male patients were more likely than female patients to have partial pre-visit PROM completion (odds ratio [OR], 1.74; p = 0.03), and Caucasian patients were more likely to have partial pre-visit PROM completion than African American patients (OR, 2.28; p = 0.01). CONCLUSIONS Orthopaedic patients receiving either e-mail or patient portal messages demonstrated higher pre-visit PROM completion rates. Pre-visit messaging appears to be a useful strategy for increasing PROM completion rates and limiting the clinical workflow strain imposed by in-clinic PROM administration. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nikhil R Yedulla
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan
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10
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Dany Mouarbes, Thomas P, Reina N, Cavaignac M, Berard E, Cavaignac E. How can augmented care experience (ACE) improve ACLR patient's participation to web questionnaires. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Anderson AM, Drew BT, Antcliff D, Redmond AC, Comer C, Smith TO, McHugh GA. Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review. Syst Rev 2022; 11:184. [PMID: 36050795 PMCID: PMC9436722 DOI: 10.1186/s13643-022-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Medicine, Keele University, Keele, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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12
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A Review of Functional Outcomes after the App-Based Rehabilitation of Patients with TKA and THA. J Pers Med 2022; 12:jpm12081342. [PMID: 36013291 PMCID: PMC9409922 DOI: 10.3390/jpm12081342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Following the outbreak of SARS-CoV-2, several elective surgeries were cancelled, and rehabilitation units were closed. This has led to difficulties for patients seeking access to rehabilitation in order to achieve the best possible outcome. New applications with or without sensors were developed to address this need, but the outcome has not been examined in detail yet. The aim of this study was to perform a systematic literature review on smart phone applications for patients suffering from hip and knee osteoarthritis after arthroplasty. The MEDLINE/PubMed and Google databases were queried using the search term “[APP] AND [ORTHOPEDIC]” according to PRISMA guidelines. All prospective studies investigating rehabilitation applications reporting the functional outcome in hip and knee osteoarthritis after arthroplasty were included. The initial search yielded 420 entries, but only 9 publications met the inclusion criteria, accounting for 1067 patients. In total, 518 patients were in the intervention group, and 549 patients were in the control group. The average follow-up was 9.5 ± 8.1 months (range: 3 to 23.4 months). Overall, significantly lower A-VAS values were observed for the interventional group in the short term (p = 0.002). There were no other significant differences observed between the two groups. Smart phone applications provide an alternative to in-person sessions that may improve access for patients after total joint arthroplasty. Our study found there are significant improvements in the short term by using this approach. In combination with a blue-tooth-enabled sensor for isometric exercises, patients can even receive real-time feedback after total knee arthroplasty.
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13
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Back DA, Estel K, Pförringer D, Tsitsilonis S, Bachner J, Willy C, Becker HP. Implementation of online video consultations in a regional health network: a management feasibility analysis from an orthopedic perspective. BMC Health Serv Res 2022; 22:1029. [PMID: 35962358 PMCID: PMC9372946 DOI: 10.1186/s12913-022-08352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective. Method The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches. Results The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future. Discussion It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08352-0.
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Affiliation(s)
- D A Back
- Charité -Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany. .,Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115, Berlin, Germany.
| | - K Estel
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115, Berlin, Germany
| | - D Pförringer
- Clinic and Policlinic for Traumatology, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
| | - S Tsitsilonis
- Charité -Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - J Bachner
- WINGS Professional Studies - MBA Healthcare Program, Wismar University of Applied Sciences, Wismar, Germany
| | - C Willy
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115, Berlin, Germany
| | | | - H P Becker
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115, Berlin, Germany
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14
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Davaris MT, Bunzli S, Trieu J, Dowsey MM, Choong PF. The role of digital health interventions to improve health literacy in surgical patients: a narrative review in arthroplasty. ANZ J Surg 2022; 92:2474-2486. [PMID: 35924880 DOI: 10.1111/ans.17931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arthroplasty is a high-volume but costly treatment option for advanced osteoarthritis. Health literacy and patient education are modifiable factors that can improve patient outcomes in arthroplasty. Digital technologies show potential as an instrument for providing patients with reliable information. This narrative review aimed to identify the current evidence for how effective digital health interventions (DHIs) are in targeting health literacy and related constructs (including knowledge, decision-making and self-efficacy) in arthroplasty. METHODS Six databases were searched for published studies comprising health literacy and related constructs, arthroplasty, and DHIs. The main outcome measure was health literacy. Two reviewer-authors independently screened studies according to predefined inclusion criteria and performed data extraction. Data was analysed and summarized in tabular and narrative form. RESULTS Two thousand seven-hundred and sixty-four titles and abstracts were screened. One hundred and sixty-seven papers underwent full-text analysis. No studies used health literacy as an outcome measure; therefore, the outcome measure was broadened to include its constructs, and the full-text analysis was repeated. Thirteen studies were included. No study following a structured design for their DHI. Eleven studies demonstrated participant improvement in constructs of health literacy, including knowledge, decision-making and self-management. CONCLUSION Current evidence suggests digital technology may provide new means of educating patients and improving aspects of their health literacy. More research digital technology with a structured approach, framework and standardized measures is required. Well-designed digital technology may become a useful adjunct to future patient care.
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Affiliation(s)
- Myles T Davaris
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason Trieu
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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15
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Zidoun Y, Kaladhara S, Powell L, Nour R, Al Suwaidi H, Zary N. Contextual Conversational Agent to address Vaccine Hesitancy: Protocol for a design-based research study. JMIR Res Protoc 2022; 11:e38043. [PMID: 35797423 PMCID: PMC9397500 DOI: 10.2196/38043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/14/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the beginning of the COVID-19 pandemic, people have been exposed to misinformation, leading to many myths about SARS-CoV-2 and the vaccines against it. As this situation does not seem to end soon, many authorities and health organizations, including the World Health Organization (WHO), are utilizing conversational agents (CAs) in their fight against it. Although the impact and usage of these novel digital strategies are noticeable, the design of the CAs remains key to their success. Objective This study describes the use of design-based research (DBR) for contextual CA design to address vaccine hesitancy. In addition, this protocol will examine the impact of DBR on CA design to understand how this iterative process can enhance accuracy and performance. Methods A DBR methodology will be used for this study. Each phase of analysis, design, and evaluation of each design cycle inform the next one via its outcomes. An anticipated generic strategy will be formed after completing the first iteration. Using multiple research studies, frameworks and theoretical approaches are tested and evaluated through the different design cycles. User perception of the CA will be analyzed or collected by implementing a usability assessment during every evaluation phase using the System Usability Scale. The PARADISE (PARAdigm for Dialogue System Evaluation) method will be adopted to calculate the performance of this text-based CA. Results Two phases of the first design cycle (design and evaluation) were completed at the time of this writing (April 2022). The research team is currently reviewing the natural-language understanding model as part of the conversation-driven development (CDD) process in preparation for the first pilot intervention, which will conclude the CA’s first design cycle. In addition, conversational data will be analyzed quantitatively and qualitatively as part of the reflection and revision process to inform the subsequent design cycles. This project plans for three rounds of design cycles, resulting in various studies spreading outcomes and conclusions. The results of the first study describing the entire first design cycle are expected to be submitted for publication before the end of 2022. Conclusions CAs constitute an innovative way of delivering health communication information. However, they are primarily used to contribute to behavioral change or educate people about health issues. Therefore, health chatbots’ impact should be carefully designed to meet outcomes. DBR can help shape a holistic understanding of the process of CA conception. This protocol describes the design of VWise, a contextual CA that aims to address vaccine hesitancy using the DBR methodology. The results of this study will help identify the strengths and flaws of DBR’s application to such innovative projects.
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Affiliation(s)
- Youness Zidoun
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
| | - Sreelekshmi Kaladhara
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
| | - Leigh Powell
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
| | - Radwa Nour
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
| | - Hanan Al Suwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, AE
| | - Nabil Zary
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare CityP.O Box 505055, Dubai, AE
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16
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Halvorson RT, Castillo FT, Ahamed F, Khattab K, Scheffler A, Matthew RP, Lotz J, Vail TP, Feeley BT, Bailey JF. Point-of-care motion capture and biomechanical assessment improve clinical utility of dynamic balance testing for lower extremity osteoarthritis. PLOS DIGITAL HEALTH 2022; 1:e0000068. [PMID: 36812556 PMCID: PMC9931224 DOI: 10.1371/journal.pdig.0000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
Musculoskeletal conditions impede patient biomechanical function. However, clinicians rely on subjective functional assessments with poor test characteristics for biomechanical outcomes because more advanced assessments are impractical in the ambulatory care setting. Using markerless motion capture (MMC) in clinic to record time-series joint position data, we implemented a spatiotemporal assessment of patient kinematics during lower extremity functional testing to evaluate whether kinematic models could identify disease states beyond conventional clinical scoring. 213 trials of the star excursion balance test (SEBT) were recorded by 36 subjects during routine ambulatory clinic visits using both MMC technology and conventional clinician scoring. Conventional clinical scoring failed to distinguish patients with symptomatic lower extremity osteoarthritis (OA) from healthy controls in each component of the assessment. However, principal component analysis of shape models generated from MMC recordings revealed significant differences in subject posture between the OA and control cohorts for six of the eight components. Additionally, time-series models of subject posture change over time revealed distinct movement patterns and reduced overall postural change in the OA cohort compared to the controls. Finally, a novel metric quantifying postural control was derived from subject specific kinematic models and was shown to distinguish OA (1.69), asymptomatic postoperative (1.27), and control (1.23) cohorts (p = 0.0025) and to correlate with patient-reported OA symptom severity (R = -0.72, p = 0.018). Time series motion data have superior discriminative validity and clinical utility than conventional functional assessments in the case of the SEBT. Novel spatiotemporal assessment approaches can enable routine in-clinic collection of objective patient-specific biomechanical data for clinical decision-making and monitoring recovery.
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Affiliation(s)
- Ryan T. Halvorson
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Francine T. Castillo
- School of Medicine, University of California San Francisco, United States of America
| | - Fayyaz Ahamed
- School of Medicine, University of California San Francisco, United States of America
| | - Karim Khattab
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Aaron Scheffler
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States of America
| | - Robert P. Matthew
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, United States of America
| | - Jeffrey Lotz
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
| | - Jeannie F. Bailey
- Department of Orthopaedic Surgery, University of California San Francisco, United States of America
- * E-mail:
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17
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Bernstein DN, van de Graaf VA, Meijers I, Portengen A, Klaassen A, Scholtes VAB, Poolman RW, Kempen DHR. Digital medical history implementation to triage orthopaedic patients during COVID-19: Findings from a rapid cycle, semi-randomised A/B testing quality improvement project. Musculoskeletal Care 2022; 20:390-395. [PMID: 34846805 PMCID: PMC9015220 DOI: 10.1002/msc.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The COVID-19 pandemic severely impacted musculoskeletal care. To better triage the notable backlog of patients, we assessed whether a digital medical history (DMH), a summary of health information and concerns completed by the patient prior to a clinic visit, could be routinely collected and utilised. METHODS We analysed 640 patients using a rapid cycle, semi-randomised A/B testing approach. Four rapid cycles of different randomised interventions were conducted across five unique patient groups. Descriptive statistics were used to report DMH completion rates by cycle/patient group and intervention. Multivariable logistic regression was used to determine whether age or anatomic injury location was associated DMH completion. ETHICAL APPROVAL N/A (Quality Improvement Project) RESULTS: Across all patients, the DMH completion rate was 48% (307/640). Phone calls were time consuming and resource intensive without an increased completion rate. The highest rate of DMH completion was among patients who were referred and called the clinic themselves (78% of patients [63 out of 81 patients]). Across all patients, increasing age (odds ratio [OR]: 0.985 (95% CI: 0.976-0.995), p = 0.002), patients with back concerns (OR: 0.395 (95% CI: 0.234-0.666), p = 0.001), and patients with non-specific/other musculoskeletal concerns (OR: 0.331 (95% CI: 0.176-0.623), p = 0.001) were associated with decreased odds of DMH completion. DISCUSSION AND CONCLUSION DMHs can be valuable in helping triage orthopaedic patients in resource-strapped settings, times of crisis, or as we transition towards value-based health care delivery. However, further work is needed to continue to increase the completion rate about 50%.
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Affiliation(s)
- David N. Bernstein
- Department of Orthopaedic SurgeryHarvard Combined Orthopaedic Residency Program (HCORP)Massachusetts General HospitalBostonMassachusettsUSA,Department of Orthopaedic SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Victor A. van de Graaf
- Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands,Department of Orthopaedic SurgerySt Antonius ZiekenhuisNieuwegeinThe Netherlands
| | - Irina Meijers
- Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands
| | - Anne Portengen
- Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands
| | - Amanda Klaassen
- Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands
| | | | - Rudolf W. Poolman
- Department of Orthopaedic SurgeryLeiden University Medical CenterLeidenThe Netherlands,Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands
| | - Diederik H. R. Kempen
- Department of Orthopaedic SurgeryJoint ResearchOLVG AmsterdamAmsterdamThe Netherlands
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18
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Wimmer MD, Welle K, Gathen M, Scheidt S, Markowetz A, Wirtz DC, Burger C, Jaenisch M, Kabir K. Video Based Assessment of Treatment Urgency in Outpatient Orthopaedic and Trauma Patients - a Pilot Trial. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022. [PMID: 35640641 DOI: 10.1055/a-1696-2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION When consulting a specialist in orthopaedics and trauma surgery, personal assessment and manual clinical examination by the doctor on site are essential. Nevertheless, implementation of video consultation hours has been made legally easier in Germany. The present pilot study examines the possibility of video-based assessment of the urgency of treatment in outpatient orthopaedic and trauma patients. MATERIALS AND METHODS Within an ex ante study design, 40 patients with an orthopaedic clinical picture for trauma surgery with elective, urgent or emergency indication were selected from consultation hours. A short questionnaire was filled in based on the information provided and a medical colleague simulated a movement sequence based on the patient information. After modification to the "red flags" and "yellow flags" established in spinal orthopaedics, nine short questions were recorded, which inquire about the urgency of a medical consultation. The video-based movement sequence is based on a 60 s long instruction video in which motor tests and movement sequences are demonstrated: Cervical spine movement in all levels, elevation of the upper extremity, test of the finger-floor distance when "bending forward over-bending", possibility of crouching from standing and getting up again, standing on heels and toes. RESULTS In 91.1% (n = 328) of the cases, the diagnosis was associated with the same joint or the same pathological entity. In 37.5% (n = 135) of the cases an emergency indication was seen, in 10.8% (n = 39) of the cases an urgent indication and in 51.6% (n = 186) of the cases it was seen to offer an elective indication. 12.5% (n = 45) of the cases were evaluated as "false positives" with regard to an emergency or urgent presentation. This means that the test persons were classified as "emergency" or "urgent", although there was no preventable dangerous course or medical emergency. 18 cases (5%) were evaluated as "false negative". DISCUSSION The screening questionnaire presented and the short video assessment are technically feasible and practicable method for the initial evaluation in video-based online medical consultation. In addition, the questionnaire presented in combination with the short video assessment was suitable as an instrument for assessing the urgency of the consultation and selecting preventable dangerous processes and acute emergencies. CONCLUSION The questionnaire, in combination with the short video assessment, is a suitable method for the social distancing requirements during limited accessibility of the medical system. Nevertheless, a false negative rate of 5% is too high to implement the questionnaire presented into daily clinics without further optimisation.
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Affiliation(s)
- Matthias D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Martin Gathen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Sebastian Scheidt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Alexander Markowetz
- Fachbereich Mathematik und Informatik, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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19
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Mojica ES, Hurley ET, Markus DH, Bloom DA, Mannino BJ, Stein SM, Jazrawi LM, Campbell KA. Female Gender Is Associated with Lower Satisfaction with Postoperative Telemedicine Visits in Sports Medicine. Telemed J E Health 2022; 28:1658-1663. [PMID: 35333658 DOI: 10.1089/tmj.2021.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine is a relatively new adjunct in orthopedic care but it has emerged from the periphery, driven in part by the COVID-19 pandemic. Although it has drastically increased in use, little is known of the factors that drive satisfaction with telemedicine. The purpose of the current study was to evaluate the patient's satisfaction with postoperative telemedicine visits in those undergoing knee or shoulder arthroscopy, and to analyze the factors associated with satisfaction with telemedicine. Methods: A prospective study was performed to evaluate satisfaction comparing postoperative telemedicine and in-office visits, in those undergoing shoulder and knee arthroscopy. Multiple factors were analyzed for correlation with satisfaction via multi-linear regression, including demographics such as gender, education, age, and race. Patients were also evaluated for preference for future visits with reference to the group in which they were placed. Results: Overall, 215 patients were included with a subgroup analysis of 93 patients receiving telemedicine visits. Patients reported overall similar satisfaction with telemedicine visits after shoulder and knee arthroscopy, with a high level of satisfaction seen in both. Female sex was found to be associated with decreasing satisfaction with telemedicine visits (p = 0.036). In addition, as a whole, the cohort was found to prefer future visits to be the same as the group they were placed in, but females statistically did not have this preference for their familiar group and were skewed toward the preference of in-person visits (p = 0.377). Conclusions: Our study found that female patients were less likely to be satisfied with postoperative telemedicine visits after knee or shoulder arthroscopy. Further, females were also less likely to indicate preference for future telemedicine visits. In contrast, education, history of prior surgery, age, and race were not associated with postoperative satisfaction.
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Affiliation(s)
- Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
- Department of Surgery, National University of Ireland Galway, Galway, Ireland
| | - Danielle H Markus
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - David A Bloom
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Brian J Mannino
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Spencer M Stein
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
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20
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Fleury AL, Goldchmit SM, Gonzales MA, de Farias RR, Fernandes TL. Innovation in Orthopedics: Part 1-Design Thinking. Curr Rev Musculoskelet Med 2022; 15:143-149. [PMID: 35286559 PMCID: PMC8918897 DOI: 10.1007/s12178-022-09748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
Purpose of Review This narrative will focus on the adoption of design thinking to improve patient-centered care innovation in Orthopedics. Recent Findings The literature reveals a complete set of applications of the design thinking approach in the different stages of the patient experience throughout the health context; however, the papers identified focus on specific parts of the process, and there is no systemic analysis about the different aspects involved in each stage of the complete experience. This review presents a holistic analysis concerning the application of design thinking to the distinct phases of innovation development in orthopedics, from the identification of the specific initial challenges up to the introduction of technology-based artifacts, such as innovations in the musculoskeletal health market. Summary Systematic description of design thinking application to orthopedics, including concepts, methods, tools, and implementation examples in the most relevant phases of the patient experience—clinical treatment, perioperative care, and rehabilitation.
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Affiliation(s)
- Andre Leme Fleury
- Production Engineering Department, School of Engineering, Universidade de Sao Paulo, Av. Prof. Luciano Gualberto, 1380, Butanta, Sao Paulo, SP, 05508-010, Brazil.
| | - Sara Miriam Goldchmit
- Design Department, School of Architecture and Urbanism, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Alice Gonzales
- Design Department, School of Architecture and Urbanism, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rafaella Rogatto de Farias
- Sports Medicine Division, Institute of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tiago Lazzaretti Fernandes
- Sports Medicine Division, Institute of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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21
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Joseph A, Olatosi B, Haider MR, Adegboyega BC, Lasebikan NN, Aliyu UM, Ali-Gombe M, Jimoh MA, Biyi-Olutunde OA, Awofeso O, Fatiregun OA, Oboh EO, Nwachukwu E, Zubairu IH, Otene SA, Iyare OI, Andero T, Musbau AB, Ajose A, Onitilo AA. Patient's Perspective on the Impact of COVID-19 on Cancer Treatment in Nigeria. JCO Glob Oncol 2022; 8:e2100244. [PMID: 35157511 PMCID: PMC8853626 DOI: 10.1200/go.21.00244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Because of the global COVID-19 pandemic, health care organizations introduced guidelines for modifications to health and cancer medical care delivery to mitigate transmission and ensure quality health outcomes. To examine the extent and impact of these modifications on oncology service disruptions in Nigeria, we surveyed oncology patients across selected public and private cancer treatment centers. Service interruptions because of the COVID-19 pandemic—Nigerian cancer patients' experience.![]()
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Bankole Olatosi
- Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
| | | | | | - Usman M Aliyu
- Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Mutiu A Jimoh
- University College Hospital, Ibadan, Oyo, Nigeria.,Lakeshore Cancer Center, Lagos, Nigeria
| | | | - Opeyemi Awofeso
- Lagos University Teaching Hospital, Idiaraba, Lagos, Nigeria
| | | | | | | | | | | | | | | | | | - Azeezat Ajose
- Lagos University Teaching Hospital, Idiaraba, Lagos, Nigeria
| | - Adedayo A Onitilo
- Department of Oncology, Marshfield Clinic Health System, Marshfield, WI
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22
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Tripuraneni KR, Foran JRH, Munson NR, Racca NE, Carothers JT. A Smartwatch Paired With A Mobile Application Provides Postoperative Self-Directed Rehabilitation Without Compromising Total Knee Arthroplasty Outcomes: A Randomized Controlled Trial. J Arthroplasty 2021; 36:3888-3893. [PMID: 34462184 DOI: 10.1016/j.arth.2021.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Self-directed rehabilitation (SDR) after total knee arthroplasty (TKA) has not been traditionally recommended. The purpose of this study was to determine if there was an impact on postoperative outcomes with the use of an SDR program after primary TKA. METHODS In this prospective, randomized, multicenter, controlled trial, we paired a smartwatch with a mobile application, providing an SDR program after TKA. Three groups were examined in this level I study: (1) control group (formal physical therapy [PT]), (2) high exercise compliance group, and (3) low exercise compliance group. Patient-reported outcome measures (PROMs) of knee injury and osteoarthritis outcome scores, joint replacement (KOOS, JR), and EuroQol five-dimension five-level (EQ-5D-5L) along with range of motion (ROM) and manipulation rates were evaluated. RESULTS Three hundred thirty-seven patients were enrolled in two groups with 184 in the control group and 153 in the study groups (90 in the high-compliance group and 63 in the low-compliance group). The KOOS, JR score was statistically lower in the low-compliance group in net change from preoperative scores at 3 months (P = .046) and 6 months (P = .032) than that in the control group; difference was noted at 6 months for the high-compliance group, P = .036. However, these did not meet the threshold of 8.02 units for KOOS JR minimal clinically important difference. No differences were seen in PROMs at other time intervals and in manipulation rates or ROM. CONCLUSION Postoperative outcomes including manipulation under anesthesia, ROM, and PROMs were not different when a smartwatch paired with a self-directed PT mobile application was compared with traditional formal PT. Surgeons can consider this an appropriate alternative to traditional PT programs after TKA.
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23
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Gathen M, Cucchi D, Jansen T, Goost H, Schildberg FA, Burger C, Wirtz DC, Kabir K, Welle K. Practicability of a Virtual Consultation to Evaluate the Shoulder Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:195-200. [PMID: 34544165 DOI: 10.1055/a-1522-9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. METHODS Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. RESULTS 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 - 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. CONCLUSION Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.
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Affiliation(s)
- Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Davide Cucchi
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Tom Jansen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Hans Goost
- Department of Orthopaedics and Trauma Surgery, Krankenhaus Wermelskirchen, Germany
| | | | - Christof Burger
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Koroush Kabir
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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Lalehzarian SP, Gowd AK, Liu JN. Machine learning in orthopaedic surgery. World J Orthop 2021; 12:685-699. [PMID: 34631452 PMCID: PMC8472446 DOI: 10.5312/wjo.v12.i9.685] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/12/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so. In prior studies, researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection, bone tumor diagnosis, detecting hip implant mechanical loosening, and grading osteoarthritis. As time goes on, the utility of artificial intelligence and machine learning algorithms, such as deep learning, continues to grow and expand in orthopaedic surgery. The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment, outcomes assessment, imaging, and basic science fields. In most cases, machine learning has proven to be just as effective, if not more effective, than prior methods such as logistic regression in assessment and prediction. With the help of deep learning algorithms, such as artificial neural networks and convolutional neural networks, artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed, flag the most critical and urgent patients for immediate attention, reduce the amount of human error, reduce the strain on medical professionals, and improve care. Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery, physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.
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Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
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Emara AK, Zhai KL, Rothfusz CA, Minkara AA, Genin J, Horton S, King D, Schaffer JL, Piuzzi NS. Virtual Orthopaedic Examination of the Lower Extremity: The Know-How of an Emerging Skill. JBJS Rev 2021; 9:01874474-202109000-00012. [PMID: 34534190 DOI: 10.2106/jbjs.rvw.21.00047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Telemedicine has become an emerging necessity in the practice of orthopaedic surgery following the paradigm shift that was brought on by the COVID-19 pandemic. » Physical examination is an integral component of orthopaedic care and plays a crucial role in diagnosis. » Based on our experience and expert opinion in the literature, we recommend the following infrastructure for a virtual orthopaedic physical examination: a computing device with a functioning camera and high-definition input/output audio, a 720p (high-definition) display, a processing speed of 3.4 GHz, an internet connection speed range from 1 to 25 Mbps, adequate lighting, a steady camera that is positioned 3 to 6 ft (0.9 to 1.8 m) from the patient, a quiet environment for the examination, and clothing that exposes the area to be examined. » When performing a virtual examination of the lower extremity, inspection, range of motion, and gait analysis can be easily translated by verbally instructing the patient to position his or her body or perform the relevant motion. Self-palpation accompanied by visual observation can be used to assess points of tenderness. Strength testing can be performed against gravity or by using household objects with known weights. Many special tests (e.g., the Thessaly test with knee flexion at 20° for meniscal tears) can also be translated to a virtual setting by verbally guiding patients through relevant positioning and motions. » Postoperative wound assessment can be performed in the virtual setting by instructing the patient to place a ruler next to the wound for measuring the dimensions and using white gauze for color control. The wound can be visually assessed when the patient's camera or smartphone is positioned 6 to 18 in (15 to 46 cm) away and is held at a 45° angle to the incision.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin L Zhai
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christopher A Rothfusz
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Anas A Minkara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jason Genin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Scott Horton
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Dominic King
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Knapp PW, Keller RA, Mabee KA, Pillai R, Frisch NB. Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology. J Arthroplasty 2021; 36:3108-3117. [PMID: 33965282 DOI: 10.1016/j.arth.2021.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Digital patient engagement has been suggested as a mean to increase patient activation and patient satisfaction after total joint arthroplasty. The purpose of this study was to assess patient engagement with application-based educational tools and to explore what content was most useful to patients in the perioperative period surrounding total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. METHODS Patients undergoing THA and TKA between October 2017 and January 2020 were enrolled to use an application-based digital technology. The App provides comprehensive patient education using a series of modules delivered at set intervals preoperatively and postoperatively. Patient engagement was defined as patients viewing at least one time the modules that were sent, or marking them as completed. Patient satisfaction was assessed using an in-application survey. RESULTS Complete data were available on 207 patients of which 95 (46%) underwent THA and 112 (54%) underwent TKA. The average age was 60 years. 54% with patients invited to the program completed registration. An average compliance rate of 48% (41 modules engaged out of 83) was observed. Of all modules completed, the top three most popular categories included physical therapy/exercise videos, health literacy, and anxiety/stress/pain management. The least viewed category was nutrition planning and education. CONCLUSION When presented educational material related to THA and TKA, patients had a high rate of compliance. Digital technology platforms provide a scalable, meaningful approach to engaging patients throughout the continuum of joint replacement care and may serve as a cost-effective adjunct to traditional methods.
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Affiliation(s)
- Paul W Knapp
- Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI
| | - Robert A Keller
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
| | - Kathryn A Mabee
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
| | - Raji Pillai
- Medical Affairs Consulting, Inc, San Francisco, CA
| | - Nicholas B Frisch
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
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Jahn HK, Jahn IHJ, Behringer W, Lyttle MD, Roland D. A survey of mHealth use from a physician perspective in paediatric emergency care in the UK and Ireland. Eur J Pediatr 2021; 180:2409-2418. [PMID: 33763717 PMCID: PMC8285308 DOI: 10.1007/s00431-021-04023-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022]
Abstract
There has been a drive towards increased digitalisation in healthcare. The aim was to provide a snapshot of current apps, instant messaging, and smartphone photography use in paediatric emergency care. A web-based self-report questionnaire was performed. Individual physicians working in paediatric emergency care recorded their personal practice. One hundred ninety-eight medical doctors completed the survey. Eight percent of respondents had access to institutional mobile devices to run medical apps. Eighty-six percent of respondents used medical apps on their personal mobile device, with 78% using Apple iOS devices. Forty-seven percent of respondents used formulary apps daily. Forty-nine percent of respondents had between 1-5 medical apps on their personal mobile device. Respondents who used medical apps had a total of 845 medical apps installed on their personal device, accounted for by 56 specific apps. The British National Formulary (BNF/BNFc) app was installed on the personal mobile device of 96% of respondents that use medical apps. Forty percent of respondents had patient confidentiality concerns when using medical apps. Thirty-eight percent of respondents have used consumer instant messaging services, 6% secure specialist messaging services, and 29% smartphone photography when seeking patient management advice. CONCLUSION: App use on the personal mobile devices, in the absence of access to institutional devices, was widespread, especially the use of a national formulary app. Instant messaging and smartphone photography were less common. A strategic decision has to be made to either provide staff with institutional devices or use software solutions to address data governance concerns when using personal devices. What is Known: • mHealth use by junior doctors and medical students is widespread. • Clinicians' use of instant messaging apps such as WhatsApp is the widespread in the UK and Ireland, in the absence of alternatives. What is New: • Personal mobile device use was widespread in the absence of alternatives, with the British National Formulary nearly universally downloaded to physicians' personal mobile devices. • A third of respondents used instant messaging and smartphone photography on their personal mobile device when seeking patient management advice from other teams in the absence of alternatives.
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Affiliation(s)
- Haiko Kurt Jahn
- Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Children’s Emergency Department, Royal Belfast Hospital for Sick Children, 274 Grosvenor Rd, Belfast, BT12 6BA UK
| | - Ingo Henry Johannes Jahn
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, QLD 4072 Australia
| | - Wilhelm Behringer
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK
- Academic Department of Emergency Care, University of the West of England, Blackberry Hill, Avon, Bristol, BS16 1DD UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, LE1 6TP UK
- Children’s Emergency Department, Royal Infirmary, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, LE1 5WW UK
| | - On behalf of Paediatric Emergency Research United Kingdom and Ireland (PERUKI)
- Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Children’s Emergency Department, Royal Belfast Hospital for Sick Children, 274 Grosvenor Rd, Belfast, BT12 6BA UK
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, QLD 4072 Australia
- Faculty of Medicine, Center of Emergency Medicine, Friedrich-Schiller-Universität Jena, Jena, Thüringen Germany
- Emergency Department, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK
- Academic Department of Emergency Care, University of the West of England, Blackberry Hill, Avon, Bristol, BS16 1DD UK
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, LE1 6TP UK
- Children’s Emergency Department, Royal Infirmary, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, LE1 5WW UK
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Patient Engagement Technologies in Orthopaedics: What They Are, What They Offer, and Impact. J Am Acad Orthop Surg 2021; 29:e584-e592. [PMID: 33826580 DOI: 10.5435/jaaos-d-20-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023] Open
Abstract
The modern era is an increasingly digital and connected world. Most of the Americans now use a smartphone irrespective of age or income level. As smartphone technologies become ubiquitous, there is tremendous interest and growth in mobile health applications. One segment of these new technologies are the so-called patient engagement platforms. These technologies present a host of features that may improve care. This article provides an introduction to this growing technology sector, offers insight into what they may offer patients and surgeons, and discusses how to evaluate various platforms.
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Siddiqi A, Piuzzi NS. Letter to the Editor: Value-based Healthcare: Not Going Anywhere-Why Orthopaedic Surgeons Will Continue Using Telehealth in a Post-COVID-19 World. Clin Orthop Relat Res 2021; 479:1398-1399. [PMID: 33739331 PMCID: PMC8133033 DOI: 10.1097/corr.0000000000001720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Ahmed Siddiqi
- A. Siddiqi, Orthopaedic Institute of Central Jersey, a division of Ortho Alliance NJ, Manasquan, NJ, USA
- N. S. Piuzzi, Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicolas S. Piuzzi
- A. Siddiqi, Orthopaedic Institute of Central Jersey, a division of Ortho Alliance NJ, Manasquan, NJ, USA
- N. S. Piuzzi, Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Almalki M. Exploring the Influential Factors of Consumers' Willingness Toward Using COVID-19 Related Chatbots: An Empirical Study. Med Arch 2021; 75:50-55. [PMID: 34012200 PMCID: PMC8116098 DOI: 10.5455/medarh.2021.75.50-55] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Consumers' willingness to use health chatbots can eventually determine if the adoption of health chatbots will succeed in delivering healthcare services for combating COVID-19. However, little research to date has empirically explored influential factors of consumer willingness toward using these novel technologies, and the effect of individual differences in predicting this willingness. Objectives This study aims to explore (a) the influential factors of consumers' willingness to use health chatbots related to COVID-19, (b) the effect of individual differences in predicting willingness, and (c) the likelihood of using health chatbots in the near future as well as the challenges/barriers that could hinder peoples' motivations. Methods An online survey was conducted which comprised of two sections. Section one measured participants' willingness by evaluating the following six factors: performance efficacy, intrinsic motivation, anthropomorphism, social influence, facilitating conditions, and emotions. Section two included questions on demographics, the likelihood of using health chatbots in the future, and concerns that could impede such motivation. Results A total of 166 individuals provided complete responses. Although 40% were aware of health chatbots and only 24% had used them before, about 84% wanted to use health chatbots in the future. The strongest predictors of willingness to use health chatbots came from the intrinsic motivation factor whereas the next strongest predictors came from the performance efficacy factor. Nearly 39.5% of participants perceived health chatbots to have human-like features such as consciousness and free will, but no emotions. About 38.4% were uncertain about the ease of using health chatbots. Conclusion This study contributes toward theoretically understanding factors influencing peoples' willingness to use COVID-19-related health chatbots. The findings also show that the perception of chatbots' benefits outweigh the challenges.
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Affiliation(s)
- Manal Almalki
- Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
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31
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Use of artificial intelligence in sports medicine: a report of 5 fictional cases. BMC Sports Sci Med Rehabil 2021; 13:13. [PMID: 33593428 PMCID: PMC7885566 DOI: 10.1186/s13102-021-00243-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Artificial intelligence (AI) is one of the most promising areas in medicine with many possibilities for improving health and wellness. Already today, diagnostic decision support systems may help patients to estimate the severity of their complaints. This fictional case study aimed to test the diagnostic potential of an AI algorithm for common sports injuries and pathologies. METHODS Based on a literature review and clinical expert experience, five fictional "common" cases of acute, and subacute injuries or chronic sport-related pathologies were created: Concussion, ankle sprain, muscle pain, chronic knee instability (after ACL rupture) and tennis elbow. The symptoms of these cases were entered into a freely available chatbot-guided AI app and its diagnoses were compared to the pre-defined injuries and pathologies. RESULTS A mean of 25-36 questions were asked by the app per patient, with optional explanations of certain questions or illustrative photos on demand. It was stressed, that the symptom analysis would not replace a doctor's consultation. A 23-yr-old male patient case with a mild concussion was correctly diagnosed. An ankle sprain of a 27-yr-old female without ligament or bony lesions was also detected and an ER visit was suggested. Muscle pain in the thigh of a 19-yr-old male was correctly diagnosed. In the case of a 26-yr-old male with chronic ACL instability, the algorithm did not sufficiently cover the chronic aspect of the pathology, but the given recommendation of seeing a doctor would have helped the patient. Finally, the condition of the chronic epicondylitis in a 41-yr-old male was correctly detected. CONCLUSIONS All chosen injuries and pathologies were either correctly diagnosed or at least tagged with the right advice of when it is urgent for seeking a medical specialist. However, the quality of AI-based results could presumably depend on the data-driven experience of these programs as well as on the understanding of their users. Further studies should compare existing AI programs and their diagnostic accuracy for medical injuries and pathologies.
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LeBrun DG, Malfer C, Wilson M, Carroll KM, Wang, MS V, Mayman DJ, Cross MB, Alexiades MM, Jerabek SA, Cushner FD, Vigdorchik JM, Haas SB, Ast MP. Telemedicine in an Outpatient Arthroplasty Setting During the COVID-19 Pandemic: Early Lessons from New York City. HSS J 2021; 17:25-30. [PMID: 33967638 PMCID: PMC8077980 DOI: 10.1177/1556331620972659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022]
Abstract
Background: The early months of the coronavirus disease 19 (COVID-19) pandemic in New York City led to a rapid transition of non-essential in-person health care, including outpatient arthroplasty visits, to a telemedicine context. Questions/Purposes: Based on our initial experiences with telemedicine in an outpatient arthroplasty setting, we sought to determine early lessons learned that may be applicable to other providers adopting or expanding telemedicine services. Methods: A cross-sectional study was performed by surveying all patients undergoing telemedicine visits with 8 arthroplasty surgeons at 1 orthopedic specialty hospital in New York City from April 8 to May 19, 2020. Descriptive statistics were used to analyze demographic data, satisfaction with the telemedicine visit, and positive and negative takeaways. Results: In all, 164 patients completed the survey. The most common reasons for the telemedicine visit were short-term (less than 6 months), postoperative appointment (n = 88; 54%), and new patient consultation (n = 32; 20%). A total of 84 patients (51%) noted a reduction in expenses versus standard outpatient care. Several positive themes emerged from patient feedback, including less anxiety and stress related to traveling (n = 82; 50%), feeling more at ease in a familiar environment (n = 54; 33%), and the ability to assess postoperative home environment (n = 13; 8%). However, patients also expressed concerns about the difficulty addressing symptoms in the absence of an in-person examination (n = 28; 17%), a decreased sense of interpersonal connection with the physician (n = 20; 12%), and technical difficulties (n = 14; 9%). Conclusions: Patients were satisfied with their telemedicine experience during the COVID-19 pandemic; however, we identified several areas amenable to improvement. Further study is warranted.
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Wainwright TW. Enhanced Recovery after Surgery (ERAS) for Hip and Knee Replacement-Why and How It Should Be Implemented Following the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 57:medicina57010081. [PMID: 33477852 PMCID: PMC7832821 DOI: 10.3390/medicina57010081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 01/02/2023]
Abstract
The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.
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Affiliation(s)
- Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89, Holdenhurst Road, Bournemouth BH8 8EB, UK; ; Tel.: +44-01202-961656
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
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Chen AZ, Shen TS, Bovonratwet P, Pain KJ, Murphy AI, Su EP. Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice. Arthroplast Today 2021; 8:15-23. [PMID: 33521188 PMCID: PMC7836630 DOI: 10.1016/j.artd.2020.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Recent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic. Methods In June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume. Results The COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees. Conclusions The COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.
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Affiliation(s)
- Aaron Z Chen
- Weill Cornell Medical College, New York, NY, USA
| | - Tony S Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Kevin J Pain
- Weill Cornell Medicine, Samuel J. Wood Library & C.V Starr Biomedical Information Center, New York, NY, USA
| | - Alexander I Murphy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Abstract
In late 2019, a previously unknown coronavirus, SARS-CoV-2 (the coronavirus that causes COVID-19), was reported in Wuhan, China. Similar to the polio virus epidemic, the fear, uncertainty, and collective response associated with COVID-19 have disrupted daily life on a global scale. In this editorial, we argue that it is time for musculoskeletal physical therapists to grasp the opportunity provided by the COVID-19 pandemic to provide care that is (1) primarily active, (2) focused on self-efficacy and self-management, and (3) far less reliant on passive therapies. J Orthop Sports Phys Ther 2021;51(1):5-7. doi:10.2519/jospt.2021.0102.
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Tijerina JD, Cohen SA, Parham MJ, Debbaut C, Cohen L, Stevanovic M, Lefebvre R. Public Interest in Elective Orthopedic Surgery Following Recommendations During COVID-19: A Google Trends Analysis. Cureus 2020; 12:e12123. [PMID: 33489537 PMCID: PMC7808963 DOI: 10.7759/cureus.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Precautions issued by organizations such as the American Academy of Orthopaedic Surgeons (AAOS) recommending against any elective, or non-essential, surgical procedures have significantly affected healthcare resource utilization by the public during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In this study, we demonstrate the value of the Google Trends (GT) interface to characterize and monitor in real-time the response in public interest toward various elective orthopedic procedures. Methods Search volume databases were generated from January 2015 to May 2020 for keywords related to anterior cruciate ligament (ACL) reconstruction, elbow arthroplasty, hip arthroplasty, knee arthroplasty, and rotator cuff repair. To measure the immediate effects on public interest, the percent change was calculated from the AAOS, and Centers for Medicare and Medicaid Services (CMS) defined a 30-day pre-recommendations period to a 30-day post-recommendations period. To measure long-term effects, mean search volumes from January 1, 2015, to February 29, 2020, were compared to mean search volumes from March 1, 2020, to May 21, 2020. Results In the 30-day period following statements by the AAOS and CMS, interest in all search terms except “partial knee arthroplasty” decreased as follows: “ACL reconstruction” (-32.7%); “ACL repair” (-22.6%); “anterior cruciate ligament reconstruction” (-39.8%); “elbow arthroplasty” (-17.2%); “elbow joint replacement” (-15.1%); “total elbow arthroplasty” (-40.0%); “hip arthroplasty” (-23.0%); “hip replacement” (-41.2%); “total hip arthroplasty” (-23.0%); “knee arthroplasty” (-43.0%); “total knee arthroplasty” (-33.3%); “rotator cuff repair” (-34.2%); “rotator cuff surgery” (-50.6%); “shoulder arthroplasty” (-26.7%). Discussion GT data have previously demonstrated utility in characterizing and anticipating shifts in real-world healthcare utilization, making it an invaluable tool for physicians to anticipate and address the emerging needs of our patient population. Our study further illustrates the value of GT in localizing rapidly recovering interest in several of the most common elective orthopedic surgeries, enabling surgeons with up-to-date actionable data to guide the management of practices and healthcare facilities as the US slowly emerges from precautions endorsed during the COVID-19 pandemic.
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Affiliation(s)
| | - Samuel A Cohen
- Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Matthew J Parham
- Health and Research Policy, Stanford University School of Medicine, Palo Alto, USA
| | | | - Landon Cohen
- Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Milan Stevanovic
- Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Rachel Lefebvre
- Orthopaedic Surgery, University of Southern California, Los Angeles, USA
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Sawhney C, Singh Y, Jain K, Sawhney R, Trikha A. Trauma care and COVID-19 pandemic. J Anaesthesiol Clin Pharmacol 2020; 36:S115-S120. [PMID: 33100659 PMCID: PMC7573987 DOI: 10.4103/joacp.joacp_272_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022] Open
Abstract
The Coronavirus SARS- CoV-2 (COVID-19) pandemic has overwhelmed the ability of health care systems all over the world. With the spread of the disease, countries have adopted different models to reorganize infrastructure and reallocate the resources to deal with the pandemic. All the nonurgent hospital services have been postponed. But, trauma and emergency services continue to function according to the established protocols with few modifications. During the pandemic, trauma care is based on clinical urgency, safety of the patient as well as health care workers (HCWs) and conservation of resources. The strategies include non-operative management if possible, restricting the number of personnel and utilization of remote consultation or telemedicine. In the present article, we discuss the triage and management of trauma victim during the pandemic, indications for emergency surgery and psychological impact of the pandemic. We also discuss the future challenges during the post-COVID-19 phase.
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Affiliation(s)
- Chhavi Sawhney
- Department of Anaesthesiology and Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology and Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Kajal Jain
- Department of Anaesthesiology, Critical Care and Pain Medicine, PGIMER, Chandigarh, India
| | - Ravindra Sawhney
- Department of Cardiac Anaesthesiology, Institute of Anaesthesiology and Critical Care, Medanta, Medicity, Gurugram, Haryana, India
| | - Anjan Trikha
- Department of Anaesthesiology and Critical Care, JPNATC, AIIMS, New Delhi, India
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi and Chairperson, Clinical Managerial Group, Covid-19 Response Team, JPNATC, AIIMS, New Delhi, India
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38
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Abdelnasser MK, Morsy M, Osman AE, AbdelKawi AF, Ibrahim MF, Eisa A, Fadle AA, Hatem A, Anter Abdelhameed M, Hassan AAA, Shawky Abdelgawaad A. COVID-19. An update for orthopedic surgeons. SICOT J 2020; 6:24. [PMID: 32609085 PMCID: PMC7328530 DOI: 10.1051/sicotj/2020022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
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Affiliation(s)
| | - Mohamed Morsy
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Ahmed E. Osman
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Amr Eisa
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr A. Fadle
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr Hatem
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Ahmed Shawky Abdelgawaad
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
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Spine center, Helios Klinikum Erfurt Nordhaeuser street 74 88089 Erfurt Germany
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39
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Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery -challenges and considerations. J Clin Orthop Trauma 2020; 11:S291-S295. [PMID: 32367999 PMCID: PMC7196552 DOI: 10.1016/j.jcot.2020.04.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on the health care systems around the world. As the disease has spread, many developed and developing countries have been stretched on their resources such as personnel as well as adequate equipment. As a result of resource disparity, in a populous country like India, the elective orthopaedic surgeries stand cancelled whilst trauma and emergency services have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines. Though these guidelines provide strategies to deal with trauma and orthopaedic surgery management in the present scenario, once the COVID-19 pandemic stabilizes, restarting elective orthopaedic surgery and managing delayed trauma conditions in evolving health care systems is going to be a profound task. We look at the future challenges and considerations of re-establishing trauma and orthopaedic flow during the post-COVID-19 phase and suggest an algorithm to follow (Fig. 1).
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Affiliation(s)
- Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK,Corresponding author.
| | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Abhishek Vaish
- Trauma and Orthopaedic Surgeon, Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Hitesh Lal
- Department of Orthopaedics, Sports Injury Centre, Safdarjung Hospital, New Delhi, India
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40
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Chauhan V, Galwankar SC, Yellapu V, Perez-Figueroa IJ, Stawicki SP. State of the Globe: The Trials and Tribulations of the COVID-19 Pandemic: Separated but Together, Telemedicine Revolution, Frontline Struggle against "Silent Hypoxia," the Relentless Search for Novel Therapeutics and Vaccines, and the Daunting Prospect of "COVIFLU". J Glob Infect Dis 2020; 12:39-43. [PMID: 32773994 PMCID: PMC7384692 DOI: 10.4103/jgid.jgid_96_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Vivek Chauhan
- Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
| | - Sagar C. Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Sarasota, Florida, USA
| | - Vikas Yellapu
- Department of Internal Medicine, St. Luke's University Health Network, Richard A. Anderson Campus, Easton, Pennsylvania, USA
| | - Ileana J. Perez-Figueroa
- Department of Family Medicine, St. Luke's University Health Network, Richard A. Anderson Campus, Easton, Pennsylvania, USA
| | - Stanislaw P. Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, University Hospital, Bethlehem, Pennsylvania, USA
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41
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Shanmugasundaram S, Vaish A, Vaishya R. Challenges in providing surgical care during and after COVID-19 pandemic. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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