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Emara KM. CORR Insights®: Is a Three-component Video-based Version of the Foot Posture Index Valid for Assessing Pediatric Patients With Orthopaedic and Neurologic Foot Conditions? Clin Orthop Relat Res 2024:00003086-990000000-01621. [PMID: 38996347 DOI: 10.1097/corr.0000000000003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Khaled M Emara
- Professor, Orthopaedic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
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2
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Farford BA, Bulbarelli EM, Ricketts I, Nath S, Ahuja AS, Keith J. Accuracy of Telehealth Visits for Acute Care Needs in Family Medicine. Cureus 2024; 16:e59569. [PMID: 38832206 PMCID: PMC11144591 DOI: 10.7759/cureus.59569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction As primary care practices transition to a post-pandemic system of healthcare, it is important to recognize the benefits of offering telehealth services. Little research is available on the effectiveness of telehealth visits for managing acute illnesses or conditions in primary care practice. Methods Using the reporting functionality in the Epic™ electronic health record (EHR) (Epic Systems Corporation, Verona), a report was generated to identify all telehealth visit encounters that were completed in a family medicine clinic from March 1, 2020, to June 30, 2020. The report identified patients who had an acute complaint and required an in-office visit within 60 days of the telehealth encounter. If the patient required a face-to-face visit, that was not directed by the provider, the chart was reviewed to determine whether the diagnosis changed. The primary outcome was returning for a face-to-face visit within 30 days of the telehealth visit for the same acute need. Results The cohort included 349 telehealth visits for 303 patients. For patients who had more than one telehealth visit, only the first one was included in the analysis. Among the 303 patients, 50 (16.5%) returned for a face-to-face visit within 30 days of the telehealth visit (95% confidence interval: 12.5%-21.2%), and 71 (23.6%) returned for a telehealth visit within 60 days (95% confidence interval: 18.9%-28.8%). Furthermore, 19 of the 50 patients (38%) that returned for a face-to-face visit did not have a change in diagnosis, and, in some instances, the diagnosis made on the telehealth visit was only slightly different from the face-to-face visit. Discussion and conclusion Telehealth, specifically two-way, synchronous, interactive patient-provider communication through audio and video equipment, for acute care needs in a primary care practice helps reduce the need for in-person visits and can address patient complaints without the need for in-person follow-up.
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Affiliation(s)
| | | | | | - Sahil Nath
- Family Medicine, Mayo Clinic, Jacksonville, USA
| | - Abhimanyu S Ahuja
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Josh Keith
- Family Medicine, Mayo Clinic, Jacksonville, USA
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3
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Hartono J, Cottrell M, Window P, Russell T. Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability. J Oral Rehabil 2024; 51:648-656. [PMID: 38151806 DOI: 10.1111/joor.13643] [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: 11/24/2022] [Revised: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount. OBJECTIVES To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests. METHOD A repeated-measures study design was undertaken. Thirty-six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in-person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests. RESULTS Agreement between telehealth and in-person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter- and intra-rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in-person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty-six individual measures produced substantial to near perfect agreement (PABAK = 0.65-0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18-0.29). CONCLUSION There is high level of agreement between telehealth and in-person measurements of TMJ physiological movement and pain provocation tests.
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Affiliation(s)
- Joseph Hartono
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Michelle Cottrell
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Peter Window
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Trevor Russell
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- RECOVER Injury Research Centre, University of Queensland, Herston, Australia
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4
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Accuracy of telemedicine for the diagnosis and treatment of patients with shoulder complaints. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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5
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Wang G, Fiedler AK, Warth RJ, Bailey L, Shupe PG, Gregory JM. Reliability and accuracy of telemedicine-based shoulder examinations. J Shoulder Elbow Surg 2022; 31:e369-e375. [PMID: 35562030 DOI: 10.1016/j.jse.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Telemedicine has become a critical component in the evaluation and management of patients with shoulder pathology. However, the interobserver reliability of findings on virtual physical examination relative to in-person evaluation is unclear. The purpose of this study was to determine the reliability of prerecorded video telemedicine for the evaluation of shoulder pathology compared with traditional in-person physical examination. METHODS New patients with unilateral shoulder pain presenting to a single-surgeon shoulder clinic were recruited between July and November 2020. In 1 visit, patients were evaluated with standardized in-person and video-guided telemedicine physical examinations in randomized order. Patients were evaluated for range of motion (ROM) and symptoms including pain, weakness, and apprehension. The telemedicine examination was recorded and consisted of a video guide displaying self-directed shoulder examination maneuvers that patients performed during remote coaching by an independent non-physician observer. The in-person physical examination was performed by the treating physician. The telemedicine videos were evaluated by two independent observers for interobserver reliability. The treating physician subsequently evaluated the telemedicine videos after a minimum two-month washout period for intraobserver reliability and intra-platform reliability. Interobserver and intraobserver reliability analyses were conducted using Kuder-Richardson formula 20 (KR-20). Specificity and likelihood ratios were calculated with P < .05 representing statistical significance. RESULTS A total of 32 patients (17 male and 15 female patients; average age, 50.2 ± 16.2 years) were included in the analysis. Overall Kuder-Richardson formula 20 (KR-20) reliability across 40 physical examination maneuvers was 0.391 ± 0.332 (76.4% ± 15.4% agreement) between the in-person and telemedicine examinations. Telemedicine maneuvers examining ROM limitations had the highest degree of reliability, sensitivity, specificity, and likelihood of also producing a positive finding on the in-person examination (0.700 ± 0.114, 66.5%, 81.0%, and 6.06, respectively). Telemedicine maneuvers identifying apprehension associated with glenohumeral instability were found to have the lowest reliability, sensitivity, and likelihood of producing a positive finding on the in-person examination (0.170 ± 0.440, 23.5%, and 0.518, respectively). All patients were satisfied with their telemedicine experience. CONCLUSION The overall reliability of a non-physician-directed video-guided telemedicine examination ranged from unacceptable to good. Shoulder ROM limitations identified during the telemedicine examinations were found to be the most reliable, whereas evaluations of instability were found to be the least reliable. Although initial telemedicine evaluation by a non-physician may be appropriate for ROM evaluation, in-person physician evaluation is recommended to confirm suspected diagnoses, especially if clinical concern for shoulder instability exists. Alternative methods of telemedicine delivery should be explored to improve the reliability of self-directed physical examination maneuvers.
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Affiliation(s)
- Grace Wang
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anna K Fiedler
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ryan J Warth
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lane Bailey
- IRONMAN Sports Medicine Institute, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Paul G Shupe
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James M Gregory
- Department of Orthopedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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6
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Savage DJ, Gutierrez O, Montané BE, Singh AD, Yudelevich E, Mahar J, Brateanu A, Khatri L, Fleisher C, Jolly SE. Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience. Postgrad Med J 2022; 98:487-491. [PMID: 33692154 PMCID: PMC7948159 DOI: 10.1136/postgradmedj-2020-139228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is one of the largest programmes in the USA, which made the task of implementing a telemedicine curriculum more complex. Here we describe our experience implementing an effective, expedited telemedicine curriculum for our ambulatory resident clinics. This study was started in April 2020 when we implemented a resident-led curriculum and training programme for providing ambulatory telemedicine care. The curriculum was finalised in less than 5 weeks. It entailed introducing a formal training programme for residents, creating a resource guide for different video communication tools and training preceptors to safely supervise care in this new paradigm. Residents were surveyed before the curriculum to assess prior experience with telemedicine, and then afterward to assess the curriculum's effectiveness. We also created a mini-CEX assessment for residents to solicit feedback on their performance during virtual appointments. Over 2000 virtual visits were performed by residents in a span of 10 weeks. Of 148 residents, 38% responded to the pre-participation survey. A majority had no prior telemedicine experience and expressed only slight comfort with the modality. Through collaboration with experienced residents and faculty, we expeditiously deployed an enhancement to our ambulatory care curriculum to teach residents how to provide virtual care and help faculty with supervision. We share our insights on this experience for other residency programmes to use.
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Affiliation(s)
- David J Savage
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Omar Gutierrez
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Eric Yudelevich
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Jamal Mahar
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Andrei Brateanu
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Lakshmi Khatri
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Fleisher
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Stacey E Jolly
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
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Rennie K, Taylor C, Corriero AC, Chong C, Sewell E, Hadley J, Ardani S. The Current Accuracy, Cost-Effectiveness, and Uses of Musculoskeletal Telehealth and Telerehabilitation Services. Curr Sports Med Rep 2022; 21:247-260. [PMID: 35801726 DOI: 10.1249/jsr.0000000000000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Musculoskeletal conditions are a major contributor to global morbidity. During the COVID-19 pandemic, clinicians needed to rapidly meet the evolving requirements of their patients, which resulted in an increased adoption of telehealth services. This area needs more research, as there is currently a paucity of studies, and telehealth practices are continuing to advance and evolve. This study subsequently aims to evaluate the ethics, health economics, and accuracy of current musculoskeletal telehealth services. This article combines three original studies; a telehealth accuracy systematic review; a cost-effectiveness scoping review; and a biopsychosocial narrative review. These studies were combined into one article. This article concludes that telehealth services achieve an average agreement with in-person assessments of 62% for the knee and 31% for the shoulder and that telerehabilitation services incur average cost savings per patient of £38.57 but that these savings are primarily a result of a reduced need to travel.
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Affiliation(s)
| | | | | | | | | | | | - Shina Ardani
- Department of Clinical Research, Sina Medical Technology, Manchester, UNITED KINGDOM
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8
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Booth G, Williams D, Patel H, Gilbert AW. What is the content of virtually delivered pain management programmes for people with persistent musculoskeletal pain? A systematic review. Br J Pain 2022; 16:84-95. [PMID: 35111317 PMCID: PMC8801687 DOI: 10.1177/20494637211023074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Virtual consultations (VC) have been embraced by healthcare organisations during the COVID-19 pandemic. VC allows continuation of patient care while adhering to government advised restrictions and social distancing measures. Multidisciplinary pain management programmes (PMPs) are a core element of many pain services and utilising virtual methods to deliver PMPs has allowed them to continue to provide care. This systematic review aimed to explore the content of existing virtually delivered PMPs and discuss if and how these findings can be used to guide clinical delivery. METHODS Eligible studies included adults (aged ⩾18 years) with persistent musculoskeletal pain and any virtually delivered intervention that was described as a PMP or that had components of PMPs. Databases were searched from inception until July 2020. We performed a content analysis comparing existing interventions with established evidence-based clinical guidelines published by the British Pain Society (BPS). Intervention reporting quality was assessed using the Template for Intervention Description and Replication (TIDieR) checklist: an established checklist developed to improve the completeness of the reporting of interventions. RESULTS Eight studies were included. One intervention included six of the seven components recommended by the BPS; none included all seven. 'Skills training and activity management' was present in all eight interventions; 'education' and 'cognitive therapy methods' were present in six interventions; 'graded activation' and 'methods to enhance acceptance, mindfulness and psychological flexibility' were present in four interventions; 'physical exercise' was present in two interventions and 'graded exposure' was present in one intervention. None of the studies described all 12 items of the TIDieR checklist adequately enough for replication. CONCLUSION Published virtual PMPs partially meet established clinical guidelines. Future virtual PMPs should be based on evidence-based clinical guidelines, and more research is needed to explore the effectiveness of virtually delivered PMPs and each recommended component.
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Affiliation(s)
- Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK,Gregory Booth, Therapies Department, Royal National Orthopaedic Hospital, Brockley Hill, Middlesex, Stanmore HA7 4LP, UK.
| | - Deborah Williams
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Hasina Patel
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK,School of Health Sciences, University of Southampton, Southampton, UK
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Davis DL, Almardawi R, Awan OA, Lo LY, Ahmed SR, Jubouri S, Gullapalli RP. Supraspinatus fatty infiltration on MRI among older adults receiving physical therapy as initial management for clinically suspected rotator cuff tear: A pilot study. J Clin Imaging Sci 2022; 12:66. [PMID: 36601603 PMCID: PMC9805608 DOI: 10.25259/jcis_138_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Rotator cuff (RC) tear is common among adults ≥60 years, with supraspinatus tear most common. Intramuscular fatty infiltration (FI) on imaging is predictive of long-term outcomes following RC tear. Physical therapists routinely diagnose RC tear only by clinical examination since most do not order imaging studies. Thus, there is limited knowledge about FI in older populations receiving physical therapy (PT) for initial management of RC tear. The primary objective of our pilot study is to determine longitudinal differences in supraspinatus FI over time among older adults receiving PT (PT cohort) for initial management of RC tear relative to older adult volunteers (control cohort), and with secondary objective to evaluate longitudinal self-reported shoulder function over time. Material and Methods This was a prospective longitudinal cohort study. Forty adults, 60-85 years, were enrolled at baseline; one follow-up visit at ≥6 months. Shoulder magnetic resonance imaging and clinical screening for Charlson comorbidity index (CCI), body mass index (BMI), and American Shoulder and Elbow Surgeon (ASES) score were completed at baseline and follow-up visits. Supraspinatus FI was evaluated by 6-point Dixon fat fraction and Goutallier grade. PT (n = 15) and control (n = 25) cohorts were stratified by supraspinatus status: Intact (no tear), partial-thickness tear (PTT), and full-thickness tear (FTT). Comparisons within cohort were performed by Kruskal-Wallis test and between cohorts by Mann-Whitney U-test. Interobserver reliability was performed for Dixon fat fraction and Goutallier grade. Results PT cohort at baseline showed no difference for age, BMI, CCI, and ASES score; supraspinatus FI was highest for FTT by Goutallier grade (no tear, 0.5 ± 0.5; PTT, 1.1 ± 0.2; and FTT, 1.5 ± 0.5; P = 0.033) and by Dixon fat fraction (no tear, 4.6% ± 1.4%; PTT, 6.1% ± 1.9%; and FTT, 6.7% ± 2.5%; P = 0.430). Control cohort at baseline showed no difference for age, BMI, CCI, and ASES score; supraspinatus FI was highest for supraspinatus FTT by Dixon fat fraction (no tear, 5.8% ± 1.2%; PTT, 7.1% ± 6.3%; and FTT, 21.4% ± 10.4%; P = 0.034) and by Goutallier grade (no tear, 0.8 ± 0.5; PTT, 1.0 ± 0.6; and FTT, 2.4 ± 1.7; P = 0.141). No difference between similar PT and control cohort subgroups at baseline except no tear groups for ASES score (PT cohort, 58.9 ± 8.2; control cohort, 84.0 ± 21.9; P = 0.049). No differences were identified for Δ-Dixon fat fraction and Δ-Goutallier grade over time in the PT and control cohorts. PT cohort no tear subgroup showed significant improvement (P = 0.042) for Δ-ASES score over time relative to PTT and FTT subgroups; no difference for Δ-ASES score over time in the control cohort. Conclusion Full-thickness RC tear showed higher levels of FI relative to PTT or no tear at baseline. Our pilot study's trend suggested that older adults receiving PT for initial management of RC tear have full-thickness RC tear for shorter duration based on relative lower levels of FI at baseline as compared to older adult volunteers with full-thickness RC tear. Our pilot study also found that older adults in the PT cohort with no tear had superior shoulder functional recovery by ASES score over time relative to full-thickness and PTTs.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Ranyah Almardawi
- Department of Epidemiology and Public Health/Pathology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Omer A Awan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Lawrence Y Lo
- Department of Radiology, The University of Chicago, Billings Hospital, Chicago, Illinios, United States
| | - Sagheer R Ahmed
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Shams Jubouri
- Department of Radiology, Benefis Health System, Great Falls, Montana, United States
| | - Rao P Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
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Bini S, Chiu YF, Ast M, Krueger C, Maratt J, Bendich I. Multicenter Evaluation of Telehealth Utilization in Hip and Knee Arthroplasty Before and for One Year During the COVID-19 Pandemic. Arthroplast Today 2021; 12:68-75. [PMID: 34632025 PMCID: PMC8486641 DOI: 10.1016/j.artd.2021.09.012] [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] [Received: 09/01/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has led to an increase in telehealth utilization across the health-care sector. It is unknown if telehealth use among hip and knee arthroplasty clinics has remained an important health-care delivery platform. The purpose of the present study was to analyze telehealth utilization before and for 1 year during the pandemic among four varied hip and knee arthroplasty clinics. METHODS Retrospective data were available from four regionally diverse hip and knee arthroplasty centers. Data on volume of patient visits, demographics, visit types (new visit, follow-up, postoperative visit, other), and visit modality (in-person, telehealth, telephone) were available from January 2020 through April 2021. Data from the centers were analyzed as a total and separately, using chi-squared and Fisher exact tests. RESULTS Among the four centers, there were 296,540 hip and knee arthroplasty outpatient clinic visits between January 2020 and April 2021. Of those, 15,240 (5%) were telehealth visits. Before March 2020, less than 0.1% of visits across centers occurred over telehealth. The highest utilization of telehealth visits occurred in March 2020 (>55%) and April 2020 (>25%). From August 2020 until April 2021, telehealth visits accounted for 2%-3% of total visits. Younger patients (<50 years old) were most likely to use telehealth. Follow-up and postoperative were the most likely telehealth visits. CONCLUSION Telehealth utilization peaked during March and April of 2020 and has since reverted to near prepandemic levels. Younger patients and lower complexity visits such as postoperative or follow-up visits are more likely to use telehealth.
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Affiliation(s)
- Stefano Bini
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Michael Ast
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Chad Krueger
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Joseph Maratt
- Department of Orthopaedic Surgery, Methodist Hospital, Indianapolis, IN, USA
| | - Ilya Bendich
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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11
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Omari AM, Antonacci CL, Zaifman J, Johal A, Conway J, Mahmood Y, Klein GR, Alberta FG, Koerner JD. Patient Satisfaction with Orthopedic Telemedicine Health Visits During the COVID-19 Pandemic. Telemed J E Health 2021; 28:806-814. [PMID: 34724833 DOI: 10.1089/tmj.2021.0170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Telemedicine usage in orthopedic surgery has seen a dramatic increase as a result of the severe acute respiratory syndrome coronavirus 2 pandemic. The purpose of this study was to examine patient perceptions with telemedicine at a large orthopedic practice. Materials and Methods: An anonymous online survey was distributed to all patients who received a telemedicine health visit at our institution for musculoskeletal complaints from March 17 to June 1, 2020. Responses were scored on a 5-point Likert scale (strongly disagree, disagree, neutral, agree, and strongly agree, 1-5) and analyzed by average score and percent reaching top box. Results: A majority of patients (76.5%) were satisfied with their visit, and only 19.2% did not want telemedicine as a future option. Patients who presented for follow-up visits (4.11 vs. 3.94, p = 0.0053; 48% vs. 41%, p = 0.02) and utilized video (4.21 vs. 3.88, p < 0.001; 51% vs. 39%, p < 0.001) were more satisfied. Average satisfaction between older (>65 years) and younger patients was similar (4.06 vs. 4.06, p = 0.97), however, younger patients were more likely to reach top box (42% vs. 51%, p < 0.001). Confidence that the physician came to the correct diagnosis (r = 0.78, p < 0.001) and receiving the same information and care as an in-office visit (r = 0.60, p < 0.001) demonstrated the strongest correlation with satisfaction and desire for future telemedicine visits, respectively. Interestingly, 31.1% of patients would have sought treatment elsewhere had telemedicine not been an option. Conclusions: Overall, satisfaction rates are high for orthopedic patients undergoing telemedicine visits. Patients are more confident in telemedicine when presenting for a follow-up visit and with the use of video.
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Affiliation(s)
- Ali M Omari
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Christopher L Antonacci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jay Zaifman
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Anmol Johal
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Jolie Conway
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Yusuf Mahmood
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Frank G Alberta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - John D Koerner
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
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12
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Al-Hazmi AM, Sheerah HA, Arafa A. Perspectives on Telemedicine during the Era of COVID-19; What Can Saudi Arabia Do? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10617. [PMID: 34682363 PMCID: PMC8535869 DOI: 10.3390/ijerph182010617] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has represented a challenge to medical practice in Saudi Arabia and worldwide. In contrary to the increasing numbers of COVID-19 patients, there was a limitation in the capacity of medical practices and access to healthcare. A growing body of evidence from healthcare settings in Saudi Arabia and worldwide has suggested a possible role for telemedicine in responding to this evolving need. Telemedicine can be used for triage, direct care, follow-up, and consultation. It could be delivered through synchronous, asynchronous, and mixed approaches. While telemedicine has several advantages, such as accessibility and cost-effectiveness, its diagnostic reliability should be further investigated. The Saudi Vision (2030) has drawn up a roadmap to invest in digital healthcare during the coming decade; however, some barriers related to using telemedicine in Saudi healthcare settings, including cultural issues and technical difficulties, should be openly discussed. In addition, before putting telemedicine in practice on a wide scale in Saudi Arabia, more efforts should be carried out to issue updated legislation and regulations, discuss and respond to ethical concerns, and ensure data security.
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Affiliation(s)
- Ali Mohsen Al-Hazmi
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Haytham A. Sheerah
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Ahmed Arafa
- Health Promotion and Health Education Research Chair, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia; (A.M.A.-H.); (A.A.)
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
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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.
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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
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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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Diagnostic Accuracy of Patient History in the Diagnosis of Hip-Related Pain: A Systematic Review. Arch Phys Med Rehabil 2021; 102:2454-2463.e1. [PMID: 33930328 DOI: 10.1016/j.apmr.2021.03.029] [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: 01/31/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of patient history associated with hip pain. DATA SOURCES A systematic, computerized search of electronic databases (PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Web of Science), a search of the gray literature, and review of the primary author's personal library was performed. Hip-specific search terms were combined with diagnostic accuracy and subjective or self-report history-based search terms using the Boolean operator "AND." STUDY SELECTION This systematic review was conducted and reported according to the protocol outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) patients with hip pain; (2) the statistical association of at least 1 patient history item was reported; (3) study designs appropriate for diagnostic accuracy; (4) adults aged ≥18 years; (5) written in English; and (6) used an acceptable reference standard for diagnosed hip pathology. Titles and abstracts of all database-captured citations were independently screened by at least 2 reviewers. DATA EXTRACTION Two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics associated with the subjective findings. DATA SYNTHESIS For hip osteoarthritis (OA), a family history of OA (positive likelihood ratio [+LR], 2.13), history of knee OA (+LR, 2.06), report of groin or anterior thigh pain (+LR, 2.51-3.86), self-reported limitation in range of motion of 1 or both hips (+LR, 2.87), constant low back pain or buttock pain (+LR, 6.50), groin pain on the same side (+LR, 3.63), and a screening questionnaire (+LR, 3.87-13.29) were the most significant findings. For intra-articular hip pathology, crepitus (+LR, 3.56) was the most significant finding. CONCLUSIONS Patient history plays a key role in differential diagnosis of hip pain and in some cases can be superior to objective tests and measures.
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Lau BC, Wittstein JR, Anakwenze OA. How Are Orthopaedic Sports Medicine Physicians Triaging Cases and Using Telehealth in Response to COVID-19? A Survey of AOSSM Membership. Orthop J Sports Med 2021; 9:2325967121990929. [PMID: 33738314 PMCID: PMC7934054 DOI: 10.1177/2325967121990929] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has changed the practice of orthopaedic sports medicine. The threat of COVID-19 persists, and future restrictions to elective procedures are possible. It is important to understand how sports surgeons are prioritizing surgical cases during elective case restrictions and how telehealth is being incorporated into practice. PURPOSE To understand how orthopaedic sports surgeons have triaged surgical sports cases and how telehealth is being utilized in response to COVID-19. STUDY DESIGN Cross-sectional study. METHODS A survey was presented to participants of the American Orthopaedic Society for Sports Medicine (AOSSM) webinar "Handling Sports and COVID-19" and distributed through email to all members of the AOSSM. The survey consisted of 25 questions with 3 sections: demographics, clinical practice, and telehealth. Descriptive statistics were performed. RESULTS Overall, 104 respondents participated. Respondents varied with respect to their location, type of clinical practice, and years in practice. The cases with the highest priority during triage included infections, fractures, and traumatic tendon ruptures (eg, quadriceps tendon). Before COVID-19, <14.0% of surgeons used telehealth, and 76.7% had never used telehealth. Now, however, 81.4% of respondents plan to use telehealth at least once a week in their practice. Respondents indicated postoperative visits and return patients as the most appropriate for telehealth. The majority felt that telehealth was not appropriate for new shoulder (65.9%) or knee (55.6%) evaluation. The leading barriers to telehealth use that were identified included, in decreasing order, concerns about clinical appropriateness, accuracy of physical examination, billing/reimbursement, and medicolegal concerns. CONCLUSION Telehealth has seen rapid adoption during the COVID-19 pandemic, and the majority of respondents plan to continue using it. It is being used more for established patients rather than new patient visits. For surgical cases, there was a clear triage priority of sports medicine cases, including infections, fractures, and traumatic tendon ruptures. Lower extremity cases had higher priority than upper extremity.
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Affiliation(s)
- Brian C. Lau
- Duke Sport Science Institute; Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, USA
| | - Jocelyn R. Wittstein
- Duke Sport Science Institute; Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, USA
| | - Oke A. Anakwenze
- Duke Sport Science Institute; Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, USA
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Lamplot JD, Taylor SA. Good Comes From Evil: COVID-19 and the Advent of Telemedicine in Orthopedics. HSS J 2021; 17:7-13. [PMID: 33967635 PMCID: PMC8077989 DOI: 10.1177/1556331620972046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Joseph D. Lamplot
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Samuel A. Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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