Telemedicine as a Therapeutic Option in Sports Medicine: Results of a Nationwide Cross-Sectional Study among Physicians and Patients in Germany

[Attitudes toward digital tools in pain medicine : Survey of German Pain Society health professional members and members of self-help groups]

Digital medicine has increasing influence on the German healthcare system. In times of social distancing during the ongoing coronavirus disease 2019 (COVID-19) pandemic, digital tools enable health professionals to maintain medical care. Furthermore, digital elements have potential to provide effective guideline-oriented treatment to a broad range of patients independently from location and time. This survey was used to assess the attitudes of members of the German Pain Society (health professionals) and of associated self-help groups (patients) towards digital medicine. It was sent out as an online survey to health professionals in September 2020 and to patients in February 2021. The survey referred especially to present usage, attitude and potential concerns regarding particular digital elements. Furthermore, technical affinity was assessed. In total, 250 health professionals and 154 patients participated in the survey. The results show that-although digital elements are already known-a substantial proportion of health professionals still lack broad transfer to regular treatment. The potential of digital tools seems to be recognized by both groups; interestingly, patients consider digital medicine as more useful than health professionals. Nevertheless, concerns about for example data security or digital competence remain in both groups. Taken together, our results indicate that disruptive changes, as the implementation of digital medicine in the healthcare system, have to be guided by intense education and channeled by political policies in order to successfully integrate digital elements into medicine on a long-term basis. This would be in favor for all involved parties and is demanded especially by patients.

Systematic evaluation of integration between China's digital economy and sports industry: Two-stage grey relational analysis and vector autoregressive model

OBJECTIVES

The development of the digital economy constitutes a key component of China's endeavors to advance towards "Digital China." The sports industry functions as a new catalyst for high-quality economic growth. This study systematically evaluated the integration between these two sectors.

METHODS

First, we conducted two levels of grey relational analysis to assess their integration between 2016 and 2021. Second, we conducted a VAR analysis to determine whether their integration between 2009 and 2021 represents a causal relationship.

RESULTS

At the macro level, the grey relational analysis reveals that the sports industry (grade = 0.770) ranked second among China's eight key economic sectors in terms of digital economy integration. At the meso level, a wide variation (ranging from 0.606 to 0.789) existed in the grade of integration between the digital economy and the sub-sectors of the sports industry. According to the VAR model, the digital economy does not Granger cause (p = 0.344) the growth of the sports industry.

CONCLUSIONS

This study yielded two added values to the existing literature: First, there exists a sectoral imbalance in the digitization process; second, the explosive growth of the sports industry was not primarily caused by the digital economy. Accordingly, the "sports + digital" complex is still in the first wave of technological integration. We propose three policy recommendations, namely, sectoral synergistic development, overtaking via esports IP, and new economy and new regulation. Collectively, these findings provide updated insights for the digital transformation towards "building a leading sports nation" and "Digital China."

Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy

BACKGROUND

The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care.

OBJECTIVE

To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT).

DESIGN

Retrospective chart review.

SETTING

Outpatient sports medicine clinic.

PATIENTS

82 patients with AT and 46 patients with PF.

INTERVENTIONS

In-person (n = 76) and telehealth (n = 52) follow-up visits.

MAIN OUTCOME MEASUREMENTS

Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level.

RESULTS

There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01).

CONCLUSIONS

Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

[The role of the Internet as a source of medical information for orthopedic patients]

INTRODUCTION

The advance of the digital revolution in medicine and health is called "e-health". The Internet serves as a digital health information platform and is indispensable as a source of medical information. The aim of this work was to examine the behavior of orthopedic patients with respect to finding information on their illnesses. The role and the importance of the Internet as an informative health application for these patients are highlighted.

MATERIALS AND METHODS

The basis of this prospective cross-sectional study was a patient survey in Germany of orthopedic patients from July 2019 to July 2020. Descriptive statistics were calculated, and regression analyses were carried out to show coherent results.

RESULTS

We analyzed the responses of 1262 orthopedic patients. Most of them used the Internet as a digital health information platform. Patients rated their Internet skills as good to very good, regardless of age or educational level. Most respondents said that they currently use the Internet at least once a week to find out about their orthopedic illnesses. Patients reported a positive change in attitude towards the Internet as a digital source of medical information, and its use has increased in the past 12 months.

CONCLUSION

The Internet as an informative digital health application in orthopedics is used intensively and is widely accepted by patients. While mistrust of orthopedic health information from the Internet has decreased, patient confidence in meaningful digital health information platforms has increased. The Internet is seen as a useful health information platform alongside medical advice.

Global Impact of the COVID-19 Pandemic on Orthopedics and the Implications of Telemedicine: A Systematic Review of the Literature

This study aimed to systematically review the literature on the impact of the coronavirus disease (COVID-19) pandemic on the orthopedics field by focusing on multiple aspects, including orthopedic training and application, performance, work loading, change of practice, research work, and other psychological factors. Published articles were searched using the PubMed database. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 58 studies published between 1 January 2020 and 1 October 2021, 57 peer-reviewed original articles were included. Nearly 90% of students experienced an impact of the pandemic on application. The impact on training stemmed from redeployment rates of 20.9–23.1%. The rate of emergency or outpatient visits decreased from 18% to 58.6%. The rates of all surgeries or emergency surgeries decreased by 15.6–49.4%, while the rates of elective surgeries decreased by 43.5–100%. The rate of work loading ranged from 33% to 66%. Approximately 50–100% of surgeons had a change of practice. A total of 40.5% of orthopedic surgeons experienced mild psychological pressure. Approximately 64% had stopped research participant recruitment. Most of the included studies were conducted in Europe, followed by Asia and North America. It is suggested orthopedic surgeons prepare more sufficient, flexible, and reservable staffing measures, proper preventive strategies and surgical scheduling algorithms, and set up dedicated venues and equipment for routine telemedicine with staff training for virtual teaching or consultations in case of future impacts on orthopedics.

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Purpose

This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed.

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible.

Results

57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%.

Conclusion

The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully.

Level of evidence

Level IV, systematic review.

Digitization in gynecology and obstetrics in times of COVID-19: Results of a national survey

INTRODUCTION

In the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. The use of telemedicine in the management of Women's Health Care could support doctors (tele-gynecology). This study analyses the use and perception of telemedicine applications among gynecologists in Germany.

MATERIALS AND METHODS

This prospective cross-sectional study was based on a survey of gynecologists in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations.

RESULTS

The gynecologists expect telemedicine to be used in gynecology and obstetrics. 76.4% (365/478) of the respondents rated their knowledge of telemedicine as insufficient. The majority of respondents (437/478, 91.6%) said they did not currently use telemedicine, although 67.3% (321/478) would like to do so. Obstacles to the introduction of telemedicine include the purchase of technical equipment (325/478, 68.1%), administration (305/478, 64.0%) and poor reimbursement (233/478, 48.9%). Gynecologists surveyed would prefer telemedicine to communicate directly with other doctors (388/478, 81.2%) rather than to communicate with patients (228/478, 47.8%). In the treatment phases, 73.2% (349/478) of the respondents would use telemedicine during follow-up. Half of the respondents would choose tele counseling as a specific approach to improving care (246/478, 51.5%).

CONCLUSION

Telemedicine in gynecology finds little use but high acceptance. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in tele-gynecology is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.