1
|
Kenter K, Bovid K, Baker EB, Carson E, Mercer D. AOA Critical Issues Symposium: Promoting Health Equity. J Bone Joint Surg Am 2024; 106:1529-1534. [PMID: 38574165 DOI: 10.2106/jbjs.23.01056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity. The COVID-19 pandemic has made us more aware of profound health-care disparities and systemic racism, which, in turn, has prompted many academic medical centers and health-care systems to increase their efforts surrounding diversity, equity, and inclusion. Therefore, it is important to understand the problems that some patients have in accessing care, promote health care that is culturally competent, create policies and standard operating procedures (at the federal, state, regional, or institutional level), and be innovative to provide cost-effective care for the underserved population. All of these efforts can assist in promoting equitable care and thus result in a more just and healthier society.
Collapse
Affiliation(s)
- Keith Kenter
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - Karen Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - E Brooke Baker
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Eric Carson
- Harlem Hospital Center, New York, NY
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
2
|
Youssef Y, Fellmer F, Gehlen T, Estel K, Tsitsilonis S, Maerdian S, Digitalisierung AG, Back DA. Joint and Functional Examinations in the Orthopaedic and Traumatological Video Consultation - What is Currently Possible? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:149-165. [PMID: 36473487 DOI: 10.1055/a-1957-5763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the context of the COVID-19 pandemic, video consultations have gained importance in orthopaedic and traumatological departments. In current literature, different adaptations of classic joint and functional examinations have been described for the virtual examination. METHODOLOGY A systematic review of current literature on adaptations for the virtual joint and functional examination in orthopaedics and trauma surgery was performed over PubMed (January 2010 to April 2021). The identified examination methods were then summarised systematically according to body region and pathology. Each examination was then described in detail and depicted in an exemplary picture. RESULTS In total 17 articles were identified and included in the analysis. Most of the examinations employed classical examination methods which were adapted so that they could be performed by the patient independently. Everyday items were described as supporting tools. In five publications, orthopaedic examinations performed in video consultations were compared to the classical examination. Results of functional examinations showed less agreement with results of classical orthopaedic examinations when compared to inspection and ROM-testing. CONCLUSION Current literature offers a substantial repertoire of examination options that can be used in the orthopaedic and traumatological video consultation. The reported examinations are mostly oriented to classical orthopaedic examinations. In future digital examinations have to be validated and possibly further adapted in future.
Collapse
Affiliation(s)
- Yasmin Youssef
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
| | - Felix Fellmer
- Klinik für Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Tobias Gehlen
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Katharina Estel
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Serafeim Tsitsilonis
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sven Maerdian
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - A G Digitalisierung
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
| | - David Alexander Back
- AG Digitalisierung, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Berlin, Deutschland
- Klinik für Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
3
|
Abbot S, Proudman S, Bednarz J, Williams N. Outcomes of proximal humerus fractures in children: a retrospective cohort study. ANZ J Surg 2024; 94:743-748. [PMID: 38366714 DOI: 10.1111/ans.18900] [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: 11/15/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs. METHODS The records of the Women's and Children's Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome. RESULTS Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically. CONCLUSION The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.
Collapse
Affiliation(s)
- Samuel Abbot
- Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia, Australia
| |
Collapse
|
4
|
Solheim E, Rosenlund M, Ulsaker KG, Parkar AP. Self-assessment of range of motion in patients undergoing surgery for a unilateral shoulder condition. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:340-347. [PMID: 37755433 PMCID: PMC10837573 DOI: 10.5152/j.aott.2023.22166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE This study aimed to investigate the agreement of patient-assessed and researcher/physician-assessed measurements of the difference in range of motion between the unaffected and affected shoulders in 55 patients undergoing arthroscopic surgery for a unilateral shoulder condition. METHODS The investigation included 55 patients (17 women and 38 men; median age=53 years; range=26-74) with a symptomatic unilateral shoulder condition and a surgically treatable diagnosis. Images of a model/researcher performing active shoulder abduction, flexion, external rotation, and internal rotation were created. Each image was paired with a degree diagram or a level system (for internal rotation) on the back for the patient to accurately self-evaluate and record. Each patient was instructed to attentively examine the figures and perform the movements with the same posture as depicted. On the day of surgery, prior to the procedure, 2 independent researchers who were not involved in the patient's care used a standard goniometer to assess the same active movements that the patient had previously self-assessed. For agreement analyses, the intraclass correlation coefficient and Bland-Altman plots were calculated for continuous data (abduction, flexion, and external rotation), and Cohen's weighted kappa was calculated for ordinal categorical data (internal rotation). RESULTS The intraclass correlation coefficient for abduction, flexion, and external rotation was 0.93 (excellent) 95% CI (0.87, 0.96), 0.89 (good) 95% CI (0.81, 0.94), and 0.72 (moderate) 95% CI (0.52, 0.84), respectively. Cohen's kappa for internal rotation (measured as reaching levels on the back) was 0.63 (moderate). CONCLUSION We believe that patient-assessed measurements of abduction (intraclass correlation coefficient 0.93) and flexion (intraclass correlation coefficient 0.89) can be used as a valid substitute (for measurements by a clinician or researcher). Patient-assessed measurements for external rotation (intraclass correlation coefficient 0.72) and internal rotation (kappa 0.63) are in moderate agreement and should be used more cautiously as substitutes. LEVEL OF EVIDENCE Level II, Diagnostic Study.
Collapse
Affiliation(s)
- Eirik Solheim
- Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway;Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway;Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Maja Rosenlund
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway
| | - Karen Gjørwad Ulsaker
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anagha P Parkar
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway; Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway
| |
Collapse
|
5
|
Rettinger L, Kuhn S. Barriers to Video Call-Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process. J Med Internet Res 2023; 25:e46715. [PMID: 37526957 PMCID: PMC10427933 DOI: 10.2196/46715] [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: 02/24/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses. OBJECTIVE This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses. METHODS A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups. RESULTS A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication. CONCLUSIONS This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers.
Collapse
Affiliation(s)
- Lena Rettinger
- Health Assisting Engineering, FH Campus Wien, University of Applied Sciences, Vienna, Austria
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Kuhn
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| |
Collapse
|
6
|
Theopold J, Osterhoff G, Melcher P, Henkelmann R, Hepp P. [Video consultation in an orthopedic trauma surgery outpatient clinic : Effective adjunctive interventions in lockdown and post-lockdown scenarios-a prospective pilot study]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:473-478. [PMID: 34189588 PMCID: PMC8240614 DOI: 10.1007/s00113-021-01032-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the regulation of the Saxon State Government and the Saxon State Ministry for Social Affairs and Social Responsibility on the modification of the Infection Protection Act of March 2020 coming into force, a video-based outpatient consultation was implemented to maintain patient care. In order to allow communication with minimized contact, this was continued after the lockdown. AIM OF THE WORK The aim of this prospective pilot study was to assess the effectiveness of a video-based outpatient consultation service, technical feasibility and control of patient flow under both lockdown and post-lockdown conditions. MATERIAL AND METHODS The initial evaluation was conducted up to 14 December 2020 when the second restrictive measures were implemented by the state government. The quality of the connections regarding sound and image was documented. Furthermore, the consequences of the conversations were documented. Distinctions were made in four categories: 1. no follow-up visit, 2. follow-up via video consultation, 3. operative intervention and 4. in-person follow-up visit for clinical examination. RESULTS There were 236 video-based outpatient consultations, 182 (82%) consultations were without restrictions and 47 (21%) consultations were initial presentations. There were no follow-up consultations in 41 (18%) patients. Video-based follow-up was scheduled in 36 (16%) patients, direct referral for surgery in 36 (16%) patients, and in-person follow-up in 105 (47%) patients. DISCUSSION In 40% of the patients a definite decision could be made by the initial video-based consultation alone. On the other hand, 47% of the patients needed in-person follow-up for a clinical examination. Thus, video consultation is a very useful measure to manage patient volume and visibly support direct doctor-patient contact.
Collapse
Affiliation(s)
- Jan Theopold
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/ Sportverletzungen, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Georg Osterhoff
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/ Sportverletzungen, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Peter Melcher
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/ Sportverletzungen, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Ralf Henkelmann
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/ Sportverletzungen, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Pierre Hepp
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/ Sportverletzungen, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| |
Collapse
|
7
|
Hepp P, Osterhoff G, Melcher P, Henkelmann R, Theopold J. Online consultation in an orthopedic trauma surgery outpatient clinic: is there a learning curve? BMC Musculoskelet Disord 2022; 23:196. [PMID: 35236325 PMCID: PMC8889387 DOI: 10.1186/s12891-022-05144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the context of the German contact restrictions due to the COVID-19 pandemic of March 2020, an online-based consultation system was established in our university orthopedic outpatient department to maintain patient care. As a basis for contact-minimizing communication, this was continued after the contact restrictions were lifted. The aim of this prospective pilot study was to assess the effectiveness, technical feasibility, and patient flow in this system under lockdown conditions and in the period afterwards. METHODS The evaluation took place from the beginning of the first lockdown on March 13, 2020, until May 31, 2021. For each patient encounter, the quality of the sound and video connections was documented. The outcomes of the consultations were recorded. Four categories were distinguished: 1) no follow-up necessary, 2) follow-up via online consultation, 3) referral for surgical therapy, and 4) follow-up in the outpatient clinic for physical examination. A comparison was made between an early cohort right after implementation of the online consultation and and a late cohort after establishment of the consultation. RESULTS There were 408 patient encounters via online consultation. A total of 360 (88%) consultations were uninterrupted. Initial presentations accounted for 124 (30%) consultations. In 75 (18%) patients, no further follow-up was necessary. Follow-up via online consultation was scheduled in 82 (20%) patients, direct referral for surgery was made in 86 (21%) patients, and a follow-up for physical examination was arranged in 165 (40%) patients. When comparing the early and late cohort, there was no difference in the duration of the conversation (p = 0.23). A significant difference was found in the type of further treatment. In the late cohort, conservative therapy was used more often (p < 0.01), resulting in a lower number of follow-up visits for clinical examination (p < 0.01). CONCLUSION While a definite decision for further procedure was possible solely by online consultation in a large percentage of cases, 40% of patients still needed an additional in-person consultation for physical examination. A learning curve could be observed regarding the selection of patients suited for online consultation. Overall, online consultation is a useful measure to manage patient volume and to visibly support direct doctor-patient contact.
Collapse
Affiliation(s)
- Pierre Hepp
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Peter Melcher
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Ralf Henkelmann
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany.
| |
Collapse
|
8
|
Boisvert-Plante V, Noutsios CD, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review. J Pain Res 2021; 14:3173-3192. [PMID: 34675645 PMCID: PMC8519790 DOI: 10.2147/jpr.s336168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.
Collapse
Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
| |
Collapse
|
9
|
Jones RB, Hubble S, Taylor L, Gunn H, Logan A, Rowland T, Bradwell H, Connolly LJ, Algie K, Anil K, Halliday B, Houston S, Dennett R, Chatfield S, Buckingham S, Freeman J. Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study. JMIRX MED 2021; 2:e30233. [PMID: 37725550 PMCID: PMC10414296 DOI: 10.2196/30233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND Understanding and assessing patients' body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. OBJECTIVE The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. METHODS We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed "Up & Go," Berg Balance Test, ankle range of motion, shoulder range of motion) as the "challenge" for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers' family members and clinical experience. RESULTS Kubi, which allowed the clinician to remotely control the patient's device, was useful for repositioning the tablet camera to gain a better view of the patient's body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. CONCLUSIONS Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient's clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.
Collapse
Affiliation(s)
- Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Suzanne Hubble
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Lloyd Taylor
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Hilary Gunn
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Angela Logan
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Tim Rowland
- Royal Cornwall Hospital Trust, Truro, United Kingdom
| | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Luke J Connolly
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Kim Algie
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Krithika Anil
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Bradley Halliday
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | | | - Rachel Dennett
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | | | - Sarah Buckingham
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| |
Collapse
|