The Hip Physical Examination for Telemedicine Encounters

Joint and Functional Examinations in the Orthopaedic and Traumatological Video Consultation - What is Currently Possible?

BACKGROUND

In the context of the COVID-19 pandemic, video consultations have gained importance in orthopaedic and traumatological departments. In current literature, different adaptations of classic joint and functional examinations have been described for the virtual examination.

METHODOLOGY

A systematic review of current literature on adaptations for the virtual joint and functional examination in orthopaedics and trauma surgery was performed over PubMed (January 2010 to April 2021). The identified examination methods were then summarised systematically according to body region and pathology. Each examination was then described in detail and depicted in an exemplary picture.

RESULTS

In total 17 articles were identified and included in the analysis. Most of the examinations employed classical examination methods which were adapted so that they could be performed by the patient independently. Everyday items were described as supporting tools. In five publications, orthopaedic examinations performed in video consultations were compared to the classical examination. Results of functional examinations showed less agreement with results of classical orthopaedic examinations when compared to inspection and ROM-testing.

CONCLUSION

Current literature offers a substantial repertoire of examination options that can be used in the orthopaedic and traumatological video consultation. The reported examinations are mostly oriented to classical orthopaedic examinations. In future digital examinations have to be validated and possibly further adapted in future.

Unlocking Opportunities for Innovation and Digitization of Musculoskeletal Care Delivery

Telemedicine is an established method of providing health care through digital mediums and has recently gained much attention within the field of orthopaedic surgery because of the social and biologic pressures imposed by COVID-19. However, a more diverse and all-encompassing concept of healthcare digitalization, deemed Telehealth , has emerged simultaneously because both healthcare providers and industries have recognized the potential efficacy and breath of applications possible with the digitalization of health care. Telehealth is a distinct concept compared with telemedicine and can be conceptualized as an umbrella term which not only encompasses telemedicine, but several digital means of healthcare services, including remote patient monitoring and physical therapy. The purpose of the current work was to comprehensively introduce the various applications of Telehealth, their relevance in the current healthcare infrastructure, and future implications for orthopaedic surgery through an evidence-based discussion and commentary.

Telemedicine Orthopedic Consultations Duration and Timing in Outpatient Clinical Practice During the COVID-19 Pandemic

Introduction: Orthopedic associations advocated telemedicine during the COVID-19 pandemic to prevent disease transmission without hindering providing services to orthopedic patients. The study aimed to evaluate outpatient orthopedic teleconsultations' timing, length, and organizational issues in the circumstances of the COVID-19 pandemic based on consecutive orthopedic teleconsultations during the period of the first lockdown. Methods: Orthopedic telemedical consultations (OTCs) were provided from March 23, 2020, to June 1, 2020, and analyzed retrospectively based on mobile smartphone billing and electronic health record. Teleconsultations were based on the legal regulations of telemedicine services in Poland. Results: One thousand seventy-one patients (514 women and 557 men) with a mean age of 41.7 were teleconsulted. The length of the OTC averagely lasted 13.36 min (standard deviation 8.63). Consulted patients suffered from orthopedic disorders 65.3%, musculoskeletal injuries 26.3%, and other diseases 8.4%. Most OTCs were delayed (74.22%) concerning the planned schedule, with a median delay time of 12 min. Only 7.3% of teleconsultations were held precisely on time. Conclusions: Televisit length may not be dependent on gender, older age, or more diagnoses. The services like e-prescriptions, e-Referrals, e-Orders for orthotics, and e-Sick-leaves influence OTC length. Any extension of the patient's OTC may create a "snowball effect" of further delay for each subsequent OTC. Orthopedic teleconsultation requires new understanding and skills by both the patient and specialist physicians. Future research directions should concern the practical aspects of orthopedic teleconsultations, like legal, organizational, and technological issues and their implementation.

Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown-Individual Observation

The COVID-19 pandemic has caused a substantial intensification of the telemedicine transformation process in orthopedics since 2020. In the light of the legal regulations introduced in Poland, from the beginning of the SARS-CoV-2 pandemic, physicians, including orthopedic surgeons, have had the opportunity to conduct specialist teleconsultations. Teleconsultations increase epidemiological safety and significantly reduce the exposure of patients and medical staff to direct transmission of the viral vector and the spread of infections. The study aimed to describe diagnoses and clinical aspects of consecutive orthopedic teleconsultations (TC) during the pandemic lockdown. The diagnoses were set according to the International Classification of Diseases (ICD-10). Hybrid teleconsultations used smartphones and obligatory Electronic Health Record (EHR) with supplemental voice, SMS, MMS, Medical images, documents, and video conferencing if necessary. One hundred ninety-eight consecutive orthopedic teleconsultations were served for 615 women and 683 men (mean age 41.82 years ± 11.47 years). The most frequently diagnosed diseases were non-acute orthopedic disorders "M" (65.3%) and injuries "S" (26.3%). Back pain (M54) was the most frequent diagnosis (25.5%). Although virtual orthopedic consultation cannot replace an entire personal visit to a specialist orthopedic surgeon, in many cases, teleconsultation enables medical staff to continue to participate in providing medical services at a sufficiently high medical level to ensure patient and physician. The unified approach to TC diagnoses using ICD-10 or ICD-11 may improve further research on telemedicine-related orthopedics repeatability. Future research directions should address orthopedic teleconsultations' practical aspects and highlight legal, organizational, and technological issues with their implementations.

Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center

Objectives:

Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.

Design:

Retrospective chart review.

Setting:

Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic.

Intervention:

Virtual visits utilizing the Doxy.me platform.

Main Outcome Measures:

Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Methods:

All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Results:

Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 (P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes (P = .028).

Conclusion:

A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine's capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers' confidence in incorporating telemedicine into their practice.