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Totala P, Janu V, Sharma RK, Agrawal M, Garg M, Gosal JS, Bhaskar S, Jha DK. Telemedicine in Follow-up after Spine Surgery: Need of the Hour. Asian J Neurosurg 2024; 19:263-269. [PMID: 38974439 PMCID: PMC11226264 DOI: 10.1055/s-0044-1787082] [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] [Indexed: 07/09/2024] Open
Abstract
Purpose There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations. Materials and Methods All patients undergoing spine surgeries including craniovertebral junction (CVJ) surgeries from January 2021 to June 2022 were included in the study. Success rate of telemedicine was calculated using a simple formula: Success rate of telemedicine = successful telemedicine consultations / total number of telemedicine consultation × 100. Success rate was evaluated with respect to demographic features and underlying disease-related factors. Results Eighty-four patients formed the study group in which a total of 181 video teleconsultations were done. Overall success rate of telemedicine was 82.87%. Higher socioeconomic and educational statuses were related to higher success rates of tele-consultations ( p < 0.05). Difficulty in assessing neurological condition using video call in follow-up cases of CVJ and issues related to Internet communication network leading to inability to video call and share image/videos were major causes of failures. Conclusion Telemedicine may prove an effective option for following up patients undergoing spine surgeries except CVJ, which is likely to improve further with improvements in Internet connectivity.
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Affiliation(s)
- Pankaj Totala
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikas Janu
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raghavendra K. Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaskaran S. Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak K. Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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2
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Restrepo JA, Henriquez R, Torre D, Graber ML. The physical exam and telehealth: between past and future. Diagnosis (Berl) 2024; 11:1-3. [PMID: 38033192 DOI: 10.1515/dx-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Jorge A Restrepo
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Richard Henriquez
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
| | - Dario Torre
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Education, Orlando VA Healthcare System, Orlando, FL, USA
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Ye IB, Thomson AE, Chowdhury N, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Telemedicine Improves Access to Care for Spine Patients With Low Socioeconomic Status. Global Spine J 2024; 14:49-55. [PMID: 35403457 PMCID: PMC9006097 DOI: 10.1177/21925682221092398] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The objective of this study is to compare the likelihood of missing a scheduled telemedicine and in-person appointments for spine patients. The secondary objective is to assess the impact of socioeconomic status on missed telemedicine and in-person appointments. METHODS Patients with scheduled outpatient appointments with orthopedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (N = 4,387) and in-person (N = 3810). Socioeconomic status was assessed using Area Deprivation Index (ADI) stratified based on percentile: low (<25), medium (25-75), and high (>75) levels of socioeconomic disadvantage. The primary outcome measure was missed clinic appointments, which was defined as having at least one appointment that was cancelled or labeled "no show." RESULTS Patients with in-person appointments missed appointments more often than patients with telemedicine visits (51.3% vs 24.7%, P < .001). Patients with high ADI missed their in-person appointments more often than patients with medium and low ADI (59.5% vs 52.2% and 47.5%, P < .001). There was no difference in missed telemedicine visits between patients with high, medium, and low ADI (27.6% vs 24.8% vs 23.8%, P = .294). Patients that missed an appointment were 41.9% more likely to be high ADI (OR 1.42, 95% CI 1.20-1.68, P < .001) and 13.4% more likely to be medium ADI (OR 1.13, 95% CI 1.03-1.26, P = .015) compared with low ADI patients. CONCLUSIONS Telemedicine may serve a role in reducing disparity in appointment attendance. While further studies are needed to validate these findings, spine surgeons should consider offering telemedicine as an option to patients.
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Affiliation(s)
- Ivan B. Ye
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alexandra E. Thomson
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Navid Chowdhury
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Brittany Oster
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Vincent S. Miseo
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Cavanaugh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Koh
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel Gelb
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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4
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Luciani AM, Parry M, Udoeyo IF, Suk M, Mercuri JJ, DelSole EM. Physician Perspectives on Telemedicine at an Integrated Health System During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1634-1641. [PMID: 36961394 DOI: 10.1089/tmj.2022.0184] [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: 03/25/2023] Open
Abstract
Introduction: The use of telemedicine (TM) for patient care greatly increased during the COVID pandemic. This study presents data from a single health system regarding physician's perspectives on TM, which could ultimately determine how it is used in the future. Methods: A questionnaire was distributed to physicians throughout the health system. Physicians were divided based on the standard level of patient interaction in each specialty, as well as practice locations and years in practice. Physician perspectives were categorized by their opinions on different aspects of telehealth visits. Results: Of 1,794 physicians, 379 (20.7%) responded to the survey. Psychiatrists used TM significantly more than other groups and project the most future use. Surgeons were least likely to incorporate TM in the future. Ability to perform a physical examination via TM differed significantly by specialty and practice environment, but not by years in practice. Frequency of being able to complete a treatment plan via TM differed significantly by specialty, but not by years in practice or practice environment. Overall, 76.3% of physicians reported feeling "satisfied" with performing TM visits. Satisfaction with TM varied significantly by specialty and practice environment, but not by years in practice. There were no significant differences regarding physician expectations on reimbursement or billing for TM visits based on specialty, age, or practice environment. Conclusions: Discrepancies exist among physicians with respect to their satisfaction and expected future use of TM. Consensus may be difficult to reach regarding reimbursement for these visits, and further work is needed to clarify the optimal practice setting for TM.
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Affiliation(s)
- A Michael Luciani
- Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Matthew Parry
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Idorenyin F Udoeyo
- Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Michael Suk
- Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - John J Mercuri
- Geisinger Community Medical Center, Scranton, Pennsylvania, USA
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Rappard G, Harb J, Yi C, Russell R. Feasibility and effectiveness of telehealth in the management of cervicothoracic and lumbar pain during the first six months of the SARS-CoV-2 pandemic: A case series. INTERVENTIONAL PAIN MEDICINE 2023; 2:100260. [PMID: 39238914 PMCID: PMC11373078 DOI: 10.1016/j.inpm.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 09/07/2024]
Abstract
Objectives The primary study objective is to assess the effectiveness and utility of telehealth in managing spine pain. The secondary objective is to evaluate the feasibility of employing various treatments utilizing telehealth. Study design Retrospective case series of patients with spinal pain managed primarily by telehealth during the first 6 months of the SARS-CoV-2 pandemic in the United States. Setting A single center community based out-patient clinic and ambulatory surgical facility. Subjects 101 consecutive adult patients complaining of cervicothoracic or low back pain presenting to a specialized spine clinic. Methods Telehealth was the preferred method of consultation for 101 consecutive patients presenting with cervicothoracic and/or low-back pain. After conservative care, patients with continued pain and disability were offered procedures. Disability Index (NDI and ODI) and pain Visual Analog Scores (VAS) were used to determine patient outcomes. Results 101 new out-patient consultations occurred. Telehealth initial consultation occurred in 98% of cases. There was a total of 504 follow up consultations. Follow up was via telehealth in 69%. Significant neurological abnormalities were detected by telehealth in 3% of patients. The lost to follow up rate was 10%. All 63 interventional procedures performed on 42 patients were completed as planned during telehealth visits. Likewise for all 9 surgical procedures. Outcomes were monitored via telehealth. Overall, for patients with cervicothoracic pain, minimal clinically important differences (MCID) for VAS or NDI were reached in 71%. Overall, the MCID for VAS or ODI for low back pain patients was reached in 70%. Conclusion Telehealth in our series was easily deployable, highly feasible, allowed accurate monitoring of patient care and resulted in accurate triaging for interventions and surgery. Overall patient outcomes compare favorably with that reported for in-person spinal pain care. Telehealth was effective and easily utilizable.
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Affiliation(s)
- George Rappard
- Los Angeles Minimally Invasive Spine Institute, 8929 Wilshire Blvd. Ste 210, Beverly Hills, California, 90211, USA
- Southern California University of Health Sciences, 16200 Amber Valley Dr, Whittier, California, 90604, USA
| | - Jake Harb
- Los Angeles Minimally Invasive Spine Institute, 8929 Wilshire Blvd. Ste 210, Beverly Hills, California, 90211, USA
| | - Caitlin Yi
- Los Angeles Minimally Invasive Spine Institute, 8929 Wilshire Blvd. Ste 210, Beverly Hills, California, 90211, USA
| | - Robb Russell
- Southern California University of Health Sciences, 16200 Amber Valley Dr, Whittier, California, 90604, USA
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6
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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7
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Eckley MJ, Hsu C, Tenforde AS. Feasibility Using Telehealth for Planning Use of Extracorporeal Shockwave Therapy in a Sports Medicine Clinic. Healthcare (Basel) 2023; 11:healthcare11111574. [PMID: 37297714 DOI: 10.3390/healthcare11111574] [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: 03/23/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The purpose of this study is to describe whether telehealth compared with in-person visits, led to a similar agreement of primary diagnosis reached at the time of procedure using extracorporeal shockwave therapy. (2) Methods: This retrospective study consisted of chart reviews of all new patients evaluated in a sports medicine clinic prior to performing extracorporeal shockwave therapy from April 2020 to March 2021. The primary outcome of the study was describing agreement in primary diagnosis at the time of evaluation (telehealth and in-person) and during the procedure using extracorporeal shockwave therapy. Logistic regression was utilized to identify patient characteristics that may predict agreement of diagnosis using telehealth. (3) Results: The chart review identified 166 patients (45 telehealth and 121 in-person) evaluated for extracorporeal shockwave therapy. Agreement of diagnosis was similar for patients evaluated using telehealth compared to in-person visits (84% vs. 92%, Χ2 = 1.90, p = 0.168). Agreement on diagnosis was more likely in patients who started shockwave within the 1 week of initial visit (OR = 8.27, 95% CI = 1.69-45.29), patients over age 60 (OR = 0.94, 95% CI = 0.90-0.99), and in patients without a history of osteoarthritis (OR = 14.00, 95% CI = 1.88-113.46). (4) Conclusions: Telehealth resulted in a similar agreement to in-person visits to identify a primary diagnosis for planning extracorporeal shockwave therapy. Telehealth may be a reasonable alternative to in-person visits for procedural planning of extracorporeal shockwave therapy.
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Affiliation(s)
- Marissa J Eckley
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
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8
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McNamee C, Rakovac A, Cawley DT. The Environmental Impact of Spine Surgery and the Path to Sustainability. Spine (Phila Pa 1976) 2023; 48:545-551. [PMID: 36580585 DOI: 10.1097/brs.0000000000004550] [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] [Received: 04/13/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVE The aim of this study was to review published literature discussing sustainable health care and to identify aspects that pertain to spine surgery. SUMMARY OF BACKGROUND DATA In recent years, research has investigated the contribution of surgical specialties to climate change. To our knowledge, no article has yet been published discussing the impact specific to spinal procedures and possible mitigation strategies. METHODS A literature search was performed for the present study on relevant terms across four electronic databases. References of included studies were also investigated. RESULTS Spine surgery has a growing environmental impact. Investigations of analogous specialties find that procurement is the single largest source of emissions. Carbon-conscious procurement strategies will be needed to mitigate this fully, but clinicians can best reduce their impact by adopting a minimalist approach when using surgical items. Reduced wastage of disposable goods and increased recycling are beneficial. Technology can aid remote access to clinicians, and also enable patient education. CONCLUSIONS Spine-surgery-specific research is warranted to evaluate its carbon footprint. A broad range of measures is recommended from preventative medicine to preoperative, intraoperative, and postoperative spine care. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Conor McNamee
- University College Dublin, National University of Ireland, Belfield, Dublin, Ireland
| | - Ana Rakovac
- Irish Doctors for the Environment
- Laboratory Medicine Department, Tallaght University Hospital, Dublin, Ireland
| | - Derek T Cawley
- Mater Private Hospital, Dublin, Ireland
- Irish Doctors for the Environment
- Department of Surgery, University of Galway, Galway, Ireland
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9
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Ma TM, Parikh NR, Philipson RG, van Dams R, Chang EM, Hegde JV, Kishan AU, Kaprealian TB, Steinberg ML, Raldow AC. Experience of Telemedicine Visits in Radiation Oncology During the COVID-19 Pandemic: A US National Survey and Lessons Learned for Incorporating Telemedicine Post-COVID-19. Adv Radiat Oncol 2023; 8:100924. [PMID: 36532603 PMCID: PMC9744187 DOI: 10.1016/j.adro.2022.100924] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/06/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose We sought to survey the attitudes and perceptions of US radiation oncologists toward the adoption of telemedicine during the COVID-19 pandemic and offer suggestions for its integration in the postpandemic era. Methods and Materials A 25-question, anonymous online survey was distributed nationwide to radiation oncologists. Results One hundred and twenty-one respondents completed the survey, with 92% from academia. Overall, 79% worked at institutions that had implemented a work-from-home policy, with which 74% were satisfied. Despite nearly all visit types being conducted in-person before COVID-19, 25%, 41%, and 5% of the respondents used telemedicine for more than half of their new consultations, follow-up, and on-treatment visits, respectively, during the COVID-19 pandemic. Most (83%) reported being comfortable integrating telemedicine. Although telemedicine was appreciated as being more convenient for patients (97%) and reducing transmission of infectious agents (83%), the most commonly perceived disadvantages were difficulty in performing physical examinations (90%), patients' inability to use technology adequately (74%), and technical malfunctions (72%). Compared with in-person visits, telemedicine was felt to be inferior in establishing a personal connection during consultation (90%) and assessing for toxicity while on-treatment (88%) and during follow-up (70%). For follow-up visits, genitourinary and thoracic were perceived as most appropriate for telemedicine while gynecologic and head and neck were considered the least appropriate. Overall, 70% were in favor of more telemedicine, even after pandemic is over. Conclusions Telemedicine will likely remain part of the radiation oncology workflow in most clinics after the pandemic. It should be used in conjunction with in-person visits, and may be best used for conducting follow-up visits in certain disease sites such as genitourinary and thoracic malignancies.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | | | - Rebecca G. Philipson
- Department of Radiation Oncology, Torrance Memorial Medical Center, Torrance, California
| | - Ritchell van Dams
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric M. Chang
- Department of Radiation Oncology, Oregon Health and Science University, Portland, Oregon
| | - John V. Hegde
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Tania B. Kaprealian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Ann C. Raldow
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California,Corresponding author: Ann C. Raldow, MD, MPH
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10
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Leung T, Sveistrup H, Bayley M, Egan M, Rathbone M, Taljaard M, Marshall S. Identification of Clinical Measures to Use in a Virtual Concussion Assessment: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e40446. [PMID: 36548031 PMCID: PMC9816949 DOI: 10.2196/40446] [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: 08/16/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Workplace concussions can have a significant impact on workers. The impact of concussion symptoms, combined with challenges associated with clinical environments that are loud, bright, and busy, create barriers to conducting effective in-person assessments. Although the opportunity for remote care in rural communities has long been recognized, the COVID-19 pandemic has catalyzed the transition to virtual assessments and care into the mainstream. With this rapid shift, many clinicians have been completing remote assessments. However, the approaches and measures used in these assessments have not yet been standardized. Furthermore, the psychometric properties of the assessments when completed remotely using videoconference have not yet been documented. OBJECTIVE Through this mixed methods study, we aim to (1) identify the concussion assessment measures clinicians are currently using in person and are most relevant to the following 5 physical domains: neurological examination (ie, cranial nerve, coordination, motor, and sensory skills), cervical spine, vestibular, oculomotor, and effort assessment; (2) document the psychometric properties of the measures identified; (3) identify measures that appear feasible in a virtual context; and (4) identify practical and technical barriers or challenges, facilitators, and benefits to conducting or engaging in virtual concussion assessments. METHODS This study will follow a sequential mixed methods design using a survey and Delphi approach, working groups with expert clinicians, and focus groups with experienced clinicians and people living with concussions. Our target sample sizes are 50 clinicians for the Delphi surveys, 4 clinician-participants for the working group, and 5-7 participants for each focus group (roughly 6-10 total groups being planned with at least two groups consisting of people living with concussions). The results from this study will inform the decision regarding the measures that should be included in a virtual assessment tool kit to be tested in a future planned prospective evaluation study. RESULTS The study is expected to be completed by January 2023. CONCLUSIONS This mixed methods study will document the clinical measures that are currently used in person and will identify those that are most relevant to assessing the physical domains impacted by concussions. Potential feasibility of using these measures in a virtual context will be explored. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40446.
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Affiliation(s)
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyere Research Institute, Ottawa, ON, Canada
| | - Mark Bayley
- Kite Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary Egan
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyere Research Institute, Ottawa, ON, Canada
| | - Michel Rathbone
- Division of Neurology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Shawn Marshall
- Bruyere Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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11
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Liu JKC, Kang R, Bilenkin A, Prorok R, Whiting J, Patel KB, Beer-Furlan A, Naso C, Rogers A, Castro XB, Peguero E, Mokhtari S, Tran N, Etame A, Pina Y, Spiess PE, Forsyth P, Vogelbaum MA. Patient satisfaction and cost savings analysis of the telemedicine program within a neuro-oncology department. J Neurooncol 2022; 160:517-525. [PMID: 36367630 PMCID: PMC9651094 DOI: 10.1007/s11060-022-04173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
Purpose Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. Methods 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity. Results Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p = 0.0089), Technology (p = 0.00187), and Overall (p = 0.00382) categories. Surgical patients returned higher scores for Access (p = 0.0015), Technology (p = 0.0002), and Overall (p = 0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p = 0.0092) for all patients, while in-person scored higher in Access (p = 0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 4.1 to 5.6 h per visit time and a potential cost savings of up to $223.3 ± 171.4. Conclusion Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04173-7
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Affiliation(s)
- James K C Liu
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA.
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Richard Kang
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Arkady Bilenkin
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rachel Prorok
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Junmin Whiting
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Krupal B Patel
- Department of Head and Neck Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andre Beer-Furlan
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Cristina Naso
- Virtual Health Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Rogers
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Xavier Baez Castro
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Edwin Peguero
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Sepideh Mokhtari
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Nam Tran
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Arnold Etame
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Yolanda Pina
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Philippe E Spiess
- Department of GU Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter Forsyth
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
| | - Michael A Vogelbaum
- Neurosurgical Oncology, Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr, Tampa,, FL 33612, USA
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12
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Nie JZ, Karras CL, Texakalidis P, Trybula SJ, Dahdaleh NS. A Systematic Review of Outpatient Telemedicine Use in Neurosurgery Since the Start of Coronavirus Disease 2019. World Neurosurg 2022; 167:e1090-e1102. [PMID: 36115568 DOI: 10.1016/j.wneu.2022.08.145] [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: 06/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has sparked interest in telemedicine, resulting in an increase in neurosurgical publications focused on it. We summarize this new literature to evaluate telemedicine applications to neurosurgery. METHODS A systematic literature review was performed in accordance with the PRISMA guidelines by searching PubMed, Embase, and Scopus for journal articles published after January 1, 2020. All journal articles that included data after the start of COVID-19 and evaluated any aspect of telemedicine relevant to outpatient neurosurgical visits were included. The premise and key findings of each included study were extracted, as well as patient and provider satisfaction with and preference for telemedicine. RESULTS Thirty-seven articles met the inclusion criteria. Four studies proposed and evaluated a remote neurologic examination. Two studies reported similar postvisit outcomes between remote and in-person visits. Twenty-four studies reported a combination of patient and provider opinions toward telemedicine. Of 9834 patients and 116 providers, 82.4% and 65.2% were satisfied overall with telemedicine, respectively. Of 3526 patients and 168 providers, 57.0% and 66.5% preferred telemedicine to in-person visits, respectively. CONCLUSIONS Overall, most patients and providers have a high opinion of telemedicine for outpatient visits, and increasing evidence suggests that remote visits yield favorable clinical outcomes. The high rates of patient and provider satisfaction and preference may be considered for further adoption of remote neurosurgical visits beyond the COVID-19 era.
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Affiliation(s)
- Jeffrey Z Nie
- Southern Illinois University School of Medicine, Springfield, Illinois, USA.
| | - Constantine L Karras
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pavlos Texakalidis
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - S Joy Trybula
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Rispoli R, Cappelletto B. Telemedicine in practice: Patient selection and strategies adopted in spinal care during the COVID-19 era and beyond. Surg Neurol Int 2022; 13:383. [PMID: 36128140 PMCID: PMC9479600 DOI: 10.25259/sni_638_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
The SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on health-care systems around the world. To deal with this challenge, we developed a prospectus design and test a teleconsultation procedure suitable for both diagnostic and therapeutic needs of outpatients in our Spine and Spinal Cord Surgery Units.
Methods:
(1) The first 15 patients received in-person and telemedicine visits: Our pilot began with screening protocol that involved 15 patients who received an in-person assessment and a telemedicine consult. The 15 patients who were selected were already known to our unit after having had at least one previous in-person visit. Further, they had to be neurologically intact or have a stable neurological examination. The secondary teleconsultation took place as a synchronous face-to-face communication between the doctor and the patient through a video interface (Lifesize Video Conferencing, Austin, Texas). If the patient demonstrated worsening of symptoms or of their condition, they were rescheduled for an immediate/timely in-person revisit with a spinal physician. (2) Fifty patients were offered telemedicine visits alone: 35 accepted: Next, from 2020 to 2021, we provided a questionnaire to 50 patients, we deemed eligible for teleconsultations: 35 agreed to the teleconsultations, while 15 refused (i.e., selecting direct in-person assessments).
Results:
We found a comparable quality for the clinical consultations/assessments provided in-person versus through telemedicine. Further, the additional 35 patients who were positively impressed with the quality of the medical care provided utilizing the telemedicine/remote visits alone.
Conclusion:
When pandemic conditions worsen, telemedicine appears to be a viable and important tool/ alternative for spinal surgeons to screen potential patients for treatment/surgery. This preliminary study suggests that a remote examination may be effective, particularly in patients who have previously undergone prior in-person evaluations.
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14
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Greven ACM, McGinley BM, Nakirikanti AS, Couceyro JD, Malcolm JG, Rodts GE, Refai D, Gary MF. Telemedicine in Spine Surgery: Outcomes for 138 Patients With Virtual Preoperative Assessment Compared to Historical Controls. World Neurosurg 2022; 161:e495-e499. [PMID: 35189421 DOI: 10.1016/j.wneu.2022.02.041] [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] [Received: 11/01/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION COVID-19 has accelerated the use of telemedicine in all aspects of health care delivery, including initial surgical evaluation. No existing literature investigates the safety and efficacy of telemedicine to preoperatively evaluate spine surgery candidates. Our objectives were: (1) Compare the change in visual analogue scale (VAS) scores between the telemedicine preoperative visit and in-person preoperative visit groups. (2) Compare the average surgical time, estimated blood loss (EBL), length of hospital stay (LOS), rates of intraoperative complications, rates of readmission, and rates of reoperation between the telemedicine preoperative visit and in-person preoperative visit groups. METHODS The previously stated metrics were collected for 276 patients, 138 who were exclusively evaluated preoperatively with telemedicine and 138 historical controls who were evaluated preoperatively in person. We used χ2 and independent samples t tests to determine significance. RESULTS There were no significant differences in the mean change in VAS scores (-2.7 ± 3.1 telemedicine vs. -2.2 ± 3.7 in-person, P = 0.317), mean percentage change in VAS scores (-40.5% ± 54.3% vs. -39.5% ± 66.6%, P = 0.811), mean surgical time (2.4 ± 1.4 hours vs. 2.3 ± 1.3 ours, P = 0.527), mean EBL (150.4 ± 173.3 mL vs. 156.7 ± 255.0 mL, P = 0.811), mean LOS (3.3 ± 2.4 days vs. 3.3 ± 2.5 days, P = 0.954), intraoperative complication rates (0.7% vs. 1.4%, P = 0.558), reoperation rates (7.9% vs. 4.3%, P = 0.208), or readmission rates (10.1% vs. 5.1%, P = 0.091) between the telemedicine preoperative visit and in-person preoperative visit groups. CONCLUSIONS Preoperative evaluation via telemedicine leads to the same short-term surgical outcomes as in-person evaluation with no increased risk of surgical complications.
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Affiliation(s)
| | | | | | | | | | - Gerald E Rodts
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Refai
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew F Gary
- Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Ye IB, Thomson AE, Donahue J, Oster B, Miseo VS, Jauregui JJ, Cavanaugh D, Koh E, Gelb D, Ludwig S. Similar Accuracy of Surgical Plans after Initial In-Person and Telemedicine Evaluation of Spine Patients. World Neurosurg 2022; 164:e1043-e1048. [DOI: 10.1016/j.wneu.2022.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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16
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Abstract
STUDY DESIGN Delphi expert panel consensus. OBJECTIVE To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery. SUMMARY OF BACKGROUND DATA Several studies have shown high patient satisfaction associated with telemedicine during the COVID-19 peak pandemic period as well as after easing of restrictions. As this technology will most likely continue to be employed, there is a need to define appropriate utilization. METHODS An expert panel consisting of 27 spine surgeons from various countries was assembled in February 2021. A two-round consensus-based Delphi method was used to generate consensus statements on various aspects of telemedicine (separated as video visits or audio visits) including themes, such as patient location and impact of patient diagnosis, on assessment of new patients. Topics with ≥75% agreement were categorized as having achieved a consensus. RESULTS The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel had consensus that video visits could be utilized regardless of patient location and that video visits are appropriate for evaluating as well as indicating for surgery multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, and cervical radiculopathy. Finally, the panel had consensus that video visits could be appropriate for a variety of visit types including early, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection). CONCLUSION Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.Level of Evidence: 4.
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17
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Grandizio LC, Barreto Rocha DF, Foster BK, Udoeyo IF. Evaluation of a Comprehensive Telemedicine Pathway for Carpal Tunnel Syndrome: A Comparison of Virtual and In-Person Assessments. J Hand Surg Am 2022; 47:111-119. [PMID: 34756618 DOI: 10.1016/j.jhsa.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/22/2021] [Accepted: 08/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated a comprehensive telemedicine pathway for carpal tunnel syndrome (CTS). Our primary aim was to compare telemedicine and in-person administration of the six item CTS-6 instrument (CTS-6) in patients undergoing carpal tunnel release (CTR) and to determine whether surgical plans determined via telemedicine were altered by in-person assessments. We additionally aimed to assess agreement between telemedicine and in-person examinations. METHODS In this prospective investigation, patients referred to a hand surgeon for evaluation of CTS were offered a telemedicine pathway. A modified, virtual CTS-6 was administered during the telemedicine consultation and a virtual exam was performed. Patients indicated for CTR were evaluated in person on the day of surgery. Agreement between the telemedicine and in-person CTS-6 and exam findings was determined. Patients were evaluated via telemedicine postoperatively to determine satisfaction with the program and assess surgical complications. RESULTS A total of 32 cases were included. The mean CTS-6 score administered via telemedicine was 17.7, compared with 16.8 in person; this difference was not statistically significant. There were no cases indicated for CTR during the telemedicine visit that had a subsequent change in management based on the in-person evaluation. Agreement was lowest for the sensory assessment (63%). The Phalen and Durkan compression tests demonstrated high levels of agreement (97% and 94%, respectively). Satisfaction was high for patients in the telemedicine CTS pathway. CONCLUSIONS Overall agreement between telemedicine and in-person administration of the CTS-6 is high for patients with CTS. In patients indicated for CTR via telemedicine, an in-person examination does not appear to alter management. The telemedicine examination of hand sensation demonstrates lower levels of agreement with the in-person assessment. Telemedicine can serve as an alternative to conventional, in-person clinic visits for the diagnosis and postoperative management of uncomplicated, primary CTS. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Louis C Grandizio
- Geisinger Medical Center, Geisinger Musculoskeletal Institute, Danville, PA.
| | | | - Brian K Foster
- Geisinger Medical Center, Geisinger Musculoskeletal Institute, Danville, PA
| | - Idorenyin F Udoeyo
- Geisinger Medical Center, Geisinger Musculoskeletal Institute, Danville, PA
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18
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Kramer ZJ, Brandt C, Havens K, Pasupuleti A, Gaillard WD, Schreiber JM. Telehealth for patients with rare epilepsies. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076861. [PMID: 37180417 PMCID: PMC10032469 DOI: 10.1177/26330040221076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 05/16/2023]
Abstract
Recent developments in technology and exigencies of the COVID-19 pandemic have spurred innovations for telehealth in patients with rare epilepsies. This review details the many ways telehealth may be used in the diagnosis and management of rare, pharmacoresistant epilepsy and documents our experience as measured by surveying caregivers of pediatric patients with epilepsy. Most components of the epilepsy evaluation, including history and examination, neuroimaging, and electroencephalogram (EEG) can be performed or reviewed remotely, assuming similar technique and quality of diagnostic studies. Seizure and epilepsy diagnosis is enhanced through the assistance of caregiver smart phone video recordings and 'ambulatory' EEG. Monitoring patient seizure frequency through paper seizure diaries is now increasingly being replaced by electronic diaries in both clinical and research settings. Electronic seizure diaries have numerous advantages such as data durability, increased accessibility, real-time availability, and easier analysis. Telehealth enhances access to specialized epilepsy care, which has been shown to reduce mortality and improve patient compliance and outcomes. Telehealth can also enable evaluation of patients with rare epilepsy in centers of excellence and enhance enrollment in clinical trials. Reducing mortality risk in patients with epilepsy can be accomplished through remote counseling and addressing psychiatric co-morbidities. Findings from surveying caregivers of children with epilepsy treated at Children's National Hospital showed that 54/56 (96.4%) found that not having to commute to the appointment positively contributed to their telemedicine experience. Overall, most respondents had a positive experience with their telemedicine visit. Almost all respondents (98%) were either 'very happy' or 'happy' with their telemedicine visit and their ability to communicate over telemedicine with the provider and either 'very likely' or 'likely' to want to use telemedicine for some future clinic visits. Telehealth in rare epilepsies is feasible and, in many ways, comparable with traditional evaluation and management.
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Affiliation(s)
- Zachary J. Kramer
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Carrin Brandt
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Kathryn Havens
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - Archana Pasupuleti
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - William D. Gaillard
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC, USA
| | - John M. Schreiber
- Department of Neurology, Children’s National
Health System, School of Medicine, The George Washington University,
Washington, DC 20010, USA
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19
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Lightsey HM, Yeung CM, Bernstein DN, Sumathipala MG, Chen AF, Schoenfeld AJ, Makhni MC. Patient Experiences of Telemedicine in Spine Care: A Mixed Methods Study. Spine (Phila Pa 1976) 2022; 47:27-33. [PMID: 34352842 DOI: 10.1097/brs.0000000000004188] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Survey-based study. OBJECTIVE We performed a mixed methods study involving patients using telemedicine for spine care. We sought to understand factors influencing the utilization and evaluation of this modality. SUMMARY OF BACKGROUND DATA Telemedicine has been integrated into routine spine care; its long-term viability will depend not only on optimizing its safety, efficiency, and cost-effectiveness, but also on understanding patient valuation of its benefits and limitations. METHODS We used a clinical registry to identify spine patients seen virtually by providers at our tertiary academic medical center between March and September of 2020. We distributed an online survey that queried patients' experiences with telemedicine. We performed statistical analyses of Likert-scale questions and a thematic analysis of free-form responses. Sociodemographic data were abstracted and analyzed. RESULTS Overall, we evaluated 139 patient surveys. High levels of patient-rated care and patient-rated experience were observed for both in-person and telemedicine visits; however, in-person visits were rated significantly higher in both respects (9.3/10 vs. 8.7/10 for patient-rated care, P < 0.001; 9.0/10 vs. 8.4/10 for patient-rated experience, P = 0.006). A preference for in-person first-time visits was observed which was not maintained for follow up appointments. Both patient and clinical factors influenced perceptions of telemedicine. Thematic analysis of free-form responses provided by 113 patients (81%) generated favorable, unfavorable, and reflective themes, each further contextualized by subthemes. Responders were not significantly different from nonresponders across sociodemographic characteristics. CONCLUSION Our quantitative and qualitative findings yield insight into the patient experience of telemedicine in spine care. A preference for in-person visits was notable, particularly for new patient evaluations. This preference was not maintained for follow-up care. Patients acknowledged the benefits of telemedicine and reflected on its effective integration with in-person care. These results may guide best practices to improve access and patient satisfaction in the future.Level of Evidence: 4.
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Affiliation(s)
- Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Caleb M Yeung
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Melvin C Makhni
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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20
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Mazarakis NK, Koutsarnakis C, Komaitis S, Drosos E, Demetriades AK. Reflections on the future of telemedicine and virtual spinal clinics in the post COVID-19 era. BRAIN AND SPINE 2022; 2:100930. [PMID: 36248094 PMCID: PMC9375852 DOI: 10.1016/j.bas.2022.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
Both patients and surgeons seem to show significant satisfaction with virtual spinal clinics. Virtual spinal clinics may be an important adjunct to traditional face-to-face clinics. Limitations in physical examination constitute main concern. Patient selection is an important factor in deciding who is a suitable candidate for a virtual spinal clinic. Medicolegal concerns need to be adequately addressed if spinal virtual clinics are to be routinely used.
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21
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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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22
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Kumar A, Sinha S, Jameel J, Kumar S. Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review. J Taibah Univ Med Sci 2021; 17:203-213. [PMID: 34690642 PMCID: PMC8521392 DOI: 10.1016/j.jtumed.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Malouff TD, TerKonda SP, Knight D, Abu Dabrh AM, Perlman AI, Munipalli B, Dudenkov DV, Heckman MG, White LJ, Wert KM, Pascual JM, Rivera FA, Shoaei MM, Leak MA, Harrell AC, Trifiletti DM, Buskirk SJ. Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience. Mayo Clin Proc Innov Qual Outcomes 2021; 5:771-782. [PMID: 34226884 PMCID: PMC8245346 DOI: 10.1016/j.mayocpiqo.2021.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate physician perceptions and attitudes toward telemedicine use at a tertiary care academic institution in northeast Florida during the coronavirus disease 2019 pandemic. PATIENTS AND METHODS An anonymous 38-question cross-sectional survey was developed using Qualtrics survey software (Qualtrics) and e-mailed to all staff physicians from all specialty disciplines at Mayo Clinic in Florida. The survey was open from August 17, 2020, through September 1, 2020. Collected data included general demographic characteristics and employment information, attitude and experience with telemedicine use before and during the coronavirus disease 2019 pandemic, perception of patients' experience, and the effect of telemedicine on burnout. RESULTS The survey was distributed to 529 eligible physicians at our institution, with 103 physicians responding (20%). The distribution of specialties was 22% primary care specialties, 41% other internal medicine subspecialties, and 18% surgical specialties. Collectively, 63% found comparable quality of care when provided virtually (vs in-person) whereas 80% perceived telemedicine as cost-effective. A total of 76% of physicians felt that telemedicine increased flexibility and control over patient care activities, with 36% reporting improved work-life balance and 30% reporting improved burnout symptoms. Overall, 42% preferred using telemedicine over in-person visits when possible. CONCLUSION Physicians generally had positive attitudes regarding the adoption of telemedicine and perceived that the quality of health care delivery as generally comparable to in-person care. Future studies are needed to explore attitudes regarding telemedicine after the pandemic and how this virtual technology may be further used to improve physicians' professional and personal well-being.
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Affiliation(s)
| | - Sarvam P. TerKonda
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Center for Connected Care, Mayo Clinic, Jacksonville, FL
| | - Dacre Knight
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Adam I. Perlman
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Bala Munipalli
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Michael G. Heckman
- Division of Biomedical Sciences and Informatics, Mayo Clinic, Jacksonville, FL
| | - Launia J. White
- Division of Biomedical Sciences and Informatics, Mayo Clinic, Jacksonville, FL
| | - Katey M. Wert
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Jorge M. Pascual
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | | | - Anna C. Harrell
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Chen JS, Buchalter DB, Sicat CS, Aggarwal VK, Hepinstall MS, Lajam CM, Schwarzkopf RS, Slover JD. Telemedicine during the COVID-19 pandemic : adult reconstructive surgery perspective. Bone Joint J 2021; 103-B:196-204. [PMID: 34053293 DOI: 10.1302/0301-620x.103b6.bjj-2020-2097.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital. METHODS A total of 334 patients underging arthroplasty of the hip or knee who completed a telemedicine visit between 30 March and 30 April 2020 were sent a 14-question survey, scored on a five-point Likert scale. Eight adult reconstructive surgeons who used telemedicine during this time were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modelling. RESULTS A total of 68 patients (20.4%) and 100% of the surgeons completed the surveys. Patients were "Satisfied" with their telemedicine visits (4.10/5.00 (SD 0.98)) and 19 (27.9%) would prefer telemedicine to in-person visits in the absence of COVID-19. Multivariate ordinal logistic regression modelling revealed that patients were more likely to be satisfied if their surgeon effectively responded to their questions or concerns (odds ratio (OR) 3.977; 95% confidence interval (CI) 1.260 to 13.190; p = 0.019) and if their visit had a high audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219; p = 0.042). Surgeons were "Satisfied" with their telemedicine experience (3.63/5.00 (SD 0.92)) and were "Fairly Confident" (4.00/5.00 (SD 0.53)) in their diagnostic accuracy despite finding the physical examinations to be only "Slightly Effective" (1.88/5.00 (SD 0.99)). Most adult reconstructive surgeons, seven of eight (87.5%) would continue to use telemedicine in the future. CONCLUSION Telemedicine emerged as a valuable tool during the COVID-19 pandemic. Patients undergoing arthroplasty and their surgeons were satisfied with telemedicine and see a role for its use after the pandemic. The audiovisual quality and the responsiveness of physicians to the concerns of patients determine their satisfaction. Future investigations should focus on improving the physical examination of patients through telemedicine and strategies for its widespread implementation. Cite this article: Bone Joint J 2021;103-B(6 Supple A):196-204.
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Affiliation(s)
- Jeffrey Shi Chen
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Chelsea S Sicat
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | | | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran S Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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25
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Crawford AM, Lightsey HM, Xiong GX, Striano BM, Greene N, Schoenfeld AJ, Simpson AK. Interventional procedure plans generated by telemedicine visits in spine patients are rarely changed after in-person evaluation. Reg Anesth Pain Med 2021; 46:478-481. [PMID: 33757998 DOI: 10.1136/rapm-2021-102630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of telemedicine in the evaluation and treatment of patients with spinal disorders is rapidly expanding, brought on largely by the COVID-19 pandemic. Within this context, the ability of pain specialists to accurately diagnose and plan appropriate interventional spine procedures based entirely on telemedicine visits, without an in-person evaluation, remains to be established. In this study, our primary objective was to assess the relevance of telemedicine to interventional spine procedure planning by determining whether procedure plans established solely from virtual visits changed following in-person evaluation. METHODS We reviewed virtual and in-person clinical encounters from our academic health system's 10 interventional spine specialists. We included patients who were seen exclusively via telemedicine encounters and indicated for an interventional procedure with documented procedural plans. Virtual plans were then compared with the actual procedures performed following in-person evaluation. Demographic data as well as the type and extent of physical examination performed by the interventional spine specialist were also recorded. RESULTS Of the 87 new patients included, the mean age was 60 years (SE 1.4 years) and the preprocedural plan established by telemedicine, primarily videoconferencing, did not change for 76 individuals (87%; 95% CI 0.79 to 0.94) following in-person evaluation. Based on the size of our sample, interventional procedures indicated solely during telemedicine encounters may be accurate in 79%-94% of cases in the broader population. CONCLUSIONS Our findings suggest that telemedicine evaluations are a generally accurate means of preprocedural assessment and development of interventional spine procedure plans. These findings clearly demonstrate the capabilities of telemedicine for evaluating spine patients and planning interventional spine procedures.
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Affiliation(s)
| | - Harry M Lightsey
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Grace X Xiong
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Nattaly Greene
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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The efficacy of remote virtual care in comparison to traditional clinical visits for elective orthopaedic patients: A meta-analysis of prospective randomised controlled trials. Surgeon 2021; 20:177-186. [PMID: 33762159 DOI: 10.1016/j.surge.2021.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The Orthopaedic Trauma Association has recommended limitation of in-person encounters to absolute necessity. One method of ensuring standard patient care within these guidelines is through the implementation of telemedicine. AIMS To evaluate the efficacy of telemedicine for elective orthopaedic patients in the recovery and/or rehabilitation period. METHODS A systematic review and meta-analysis of articles in Medline/PubMed and The Cochrane Library databases was performed according to the PRISMA guidelines for prospective randomised controlled trials to compare clinical and symptomatic measures for elective patients managed routinely with remote care compared to those managed with standard in-clinic management. To be included for meta-analysis, parameters must be evaluated in ≥3 studies. RESULTS Eleven studies were included in the meta-analyses. Both telemedicine and control cohorts were comparable for patient satisfaction (RR, 0.98; 95% CI, 0.90-1.07; I2 = 0%; p = 0.52) and patient retention analysis (RR, 1.25; 95% CI, 0.51-3.06; p = 0.54; I2 = 0%). Similarly, there was no statistical difference appreciated between cohorts for overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (p = 0.30), Timed Up and Go Test (p = 0.40), and Stair Test (p = 0.18). Significant difference did exist for visual analogue scale (VAS) scores (p = 0.02) in favour of in-clinic management. CONCLUSION Telemedicine will serve an integral aspect of healthcare delivery throughout the current COVID-19 pandemic and beyond in an effort to deliver safe, efficient and time-sensitive care to the orthopaedic patient population. The results of our meta-analyses indicate that virtual consultations are as effective as traditional in-person consultations for the care of elective orthopaedic patients in the recovery and rehabilitation period. However, further studies are needed to evaluate for initial consultations and certain sub-specialties of orthopaedics.
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Lightsey HM, Crawford AM, Xiong GX, Schoenfeld AJ, Simpson AK. Surgical plans generated from telemedicine visits are rarely changed after in-person evaluation in spine patients. Spine J 2021; 21:359-365. [PMID: 33227550 DOI: 10.1016/j.spinee.2020.11.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The role of telemedicine within the realm of spine surgery is evolving, catalyzed by the recent pandemic. Specifically, the capability of this technology to provide high-quality, cost-effective care without an in-person interaction and physical examination remains poorly defined. PURPOSE To characterize the impact of telemedicine on spine surgical planning by assessing whether surgical plans established in virtual visits changed following in-person evaluation. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE We evaluated the records of patients who were indicated for surgery with documented specific surgical plans during a virtual encounter (March-July 2020) and underwent subsequent in-person evaluation prior to surgery. OUTCOME MEASURES We determined whether surgical plans changed between the virtual encounter and the in-person interaction. Secondarily, we reviewed use of the virtual physical examination across surgeons. METHODS We reviewed virtual and in-person clinical encounters from a single academic spine division, evaluating those patients who were seen exclusively via telemedicine encounters and indicated for surgery with documented specific surgical plans. These plans were compared to the surgical plan after these same patients underwent in-person evaluation. Demographic data, patient primary complaint, and the type and extent of physical examination performed by the surgeon were recorded. RESULTS Of the 33 patients included, the surgical plan did not change among 31 individuals (94%) following in-person interaction. For the two patients where surgical plans were modified, multilevel fusions were increased by one level. There was notable inter- and intra-surgeon variability with regard to the use of virtual physical exams. CONCLUSIONS Our findings suggest that telemedicine evaluations are efficient means of preoperative assessment of spine patients and delineation of surgical plans. These results may support innovations that can optimize access to care for patients.
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Affiliation(s)
- Harry M Lightsey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Alexander M Crawford
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Grace X Xiong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA.
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Spine surgeon perceptions of the challenges and benefits of telemedicine: an international study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2124-2132. [PMID: 33452924 PMCID: PMC7811153 DOI: 10.1007/s00586-020-06707-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
Introduction While telemedicine usage has increased due to the COVID-19 pandemic, there remains little consensus about how spine surgeons perceive virtual care. The purpose of this study was to explore international perspectives of spine providers on the challenges and benefits of telemedicine. Methods Responses from 485 members of AO Spine were analyzed, covering provider perceptions of the challenges and benefits of telemedicine. All questions were optional, and blank responses were excluded from analysis. Results The leading challenges reported by surgeons were decreased ability to perform physical examinations (38.6%), possible increased medicolegal exposure (19.3%), and lack of reimbursement parity compared to traditional visits (15.5%). Fewer than 9.0% of respondents experienced technological issues. On average, respondents agreed that telemedicine increases access to care for rural/long-distance patients, provides societal cost savings, and increases patient convenience. Responses were mixed about whether telemedicine leads to greater patient satisfaction. North Americans experienced the most challenges, but also thought telemedicine carried the most benefits, whereas Africans reported the fewest challenges and benefits. Age did not affect responses. Conclusion Spine surgeons are supportive of the benefits of telemedicine, and only a small minority experienced technical issues. The decreased ability to perform the physical examination was the top challenge and remains a major obstacle to virtual care for spine surgeons around the world, although interestingly, 61.4% of providers did not acknowledge this to be a major challenge. Significant groundwork in optimizing remote physical examination maneuvers and achieving legal and reimbursement clarity is necessary for widespread implementation.
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