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Cook AK, Papp BM, Kalpakjian CZ, Daunter AK. Visual aid for pediatric virtual musculoskeletal exams: A Barbie girl in a telehealth world. PM R 2024; 16:356-362. [PMID: 38545718 DOI: 10.1002/pmrj.13167] [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: 09/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. OBJECTIVE To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. DESIGN Randomized controlled trial. SETTING Mock telehealth encounter. PARTICIPANTS A total of 30 volunteer dyads of children aged 4-17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. INTERVENTION The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. MAIN OUTCOME MEASURES Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. RESULTS The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group (p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 (p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 (p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers (p = .255), total time (p = .061) or total verbal prompts (p = .095). However, group allocation significantly predicted total verbal prompts (p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as 'definitely helpful'. CONCLUSION Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.
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Affiliation(s)
- Alyssa K Cook
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Britney M Papp
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine & Rehabilitation, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
| | - Claire Z Kalpakjian
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Alecia K Daunter
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Das L, Sharma PK, Singh G, Goyal T. Telerehabilitation is as effective as outpatient visits in the management of early osteoarthritis knee and mechanical low backache. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:405-413. [PMID: 37566137 DOI: 10.1007/s00590-023-03673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Teleconsultation services can be used to overcome the barriers imposed by the Covid-19 pandemic in providing basic orthopaedic rehabilitation services. Aim of the study is to compare the effectiveness of rehabilitation provided via outpatient and teleconsultation in patients with mechanical low backache (LBA) and early osteoarthritis (OA) of the knee joint utilizing Patient-Reported Outcome Measures. The satisfaction level of patients receiving teleconsultation will also be assessed. METHODOLOGY This study was a hospital-based prospective observational study. The study's participants were divided into two groups (Outpatient and Teleconsultation, respectively), and each group was further divided into two subgroups of 100 participants each (Knee-pain subgroup 1; LBA subgroup 2). SF-12 questionnaire, visual analogue scale (VAS) score for pain, and functional outcome scores (KOOS score for knee pain and the modified Oswestry Disability Index-MODI for LBA) were assessed at initial presentation and 6 months follow-up. Participants' satisfaction for teleconsultation service was assessed at final follow-up by 5 points Likert scale (5, very satisfied; 1, very dissatisfied). RESULTS Mean consultation time was significantly longer in the outpatient group (p < 0.001). No statistically significant difference in the VAS score, KOOS score (58.0 ± 7.6 vs. 57.8 ± 9.2; p = 0.893), and MODI Score (24.7 ± 13.3 vs. 27.4 ± 12.4; p = 0.128) between the corresponding subgroups of the two groups at final follow-up. Eighty-seven percentage of the participants were satisfied (Likert score ≥ 4) with the teleconsultation services. CONCLUSION Teleconsultation is equally effective to that as face-to-face outpatient consultation in the rehabilitation of patients with early OA knee and mechanical LBA. LEVEL OF STUDY Level 2, Prospective comparative study.
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Affiliation(s)
- Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Gaganpreet Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda , Punjab, 151001, India.
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Daentzer D. Video Consultations and Their Utilization by Orthopedic and Trauma Surgeons During the COVID-19 Pandemic. A Go-To Technology in the Future or Just a Stopgap? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:29-41. [PMID: 34255343 DOI: 10.1055/a-1471-8919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the contact restrictions imposed for protection against infection have limited the options for direct medical therapy. Considering this, the present study aimed to evaluate the utility of the rarely used online video consultation as an alternative treatment form for orthopedic and trauma surgeons and analyze its potential for future use. METHODS During calendar week 24 in the year 2020, 215 specialists in orthopedics and orthopedics and trauma surgery in the city and greater region of Hanover, Germany, were enrolled in a questionnaire-based evaluation of their use of video consultations. The analysis consisted of 125 completed questionnaires, which corresponded to a return rate of 58.1%. The completed questionnaires recorded the number of users, frequency of utilization, and advantages and disadvantages of online treatment, as well as provided an assessment of the future use of telemedicine and video consultations. Furthermore, we considered the necessary requirements for using video consultations and for continuing their use in the future as well as the potential of performing online consultations given that all pertinent conditions are fulfilled. RESULTS Among the 125 respondents, only 17 (13.6%) had already experienced video consultations, all starting during the COVID-19 pandemic, but with very low frequencies (maximum of one-three times per week). Despite the limitations, the advantages included helping patients receive the required treatments and reducing the need for travel. However, the respondents mentioned that there were several disadvantages due to diagnostic limitations: there was no direct examination, primary consultations were restricted, and possibilities of consultations and explanations were reduced. Of the 108 (86.4%) respondents who had not experienced video consultations, only 9 (8.3%) had specifically planned to conduct online consultation, whereas 57 (52.8%) had no such intention in the foreseeable future and 42 (38.9%) were undecided on this point. They stated diagnostic limitations because of the lack of direct examination (44/77.2%) and the indispensable personal contact with the patient (30/52.6%) as main counter-arguments. According to all the respondents, the main requirements for the implementation of video consultations included establishment of proper technology (81.6%), adequate remuneration (61.6%), legal certainty (58.4%), fast and unbureaucratic support for installation and in case of problems (51.2%), and a manageable bureaucracy during the initial period (44.8%). CONCLUSION Video consultations and telemedicine in general undoubtedly have advantages, primarily concerning the protection from infection and contact restrictions, which are increasingly requested by patients. However, the collected data indicate that this approach may remain less important than personal consultations in the field of orthopedics and trauma surgery. As suggested by available data, this does not apply to other fields such as psychotherapy or general medicine.
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Affiliation(s)
- Dorothea Daentzer
- Wirbelsäulendepartment, Orthopädische Klinik der MHH im DIAKOVERE Annastift, Hannover
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Boisvert-Plante V, Noutsios CD, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review. J Pain Res 2021; 14:3173-3192. [PMID: 34675645 PMCID: PMC8519790 DOI: 10.2147/jpr.s336168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.
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Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
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Ruelos VCB, Puzzitiello RN, Menendez ME, Moverman MA, Pagani NR, Rogerson A, Ryan SP, Salzler MJ. Patient Perceptions of Telehealth Orthopedic Services in the Era of COVID-19 and Beyond. Orthopedics 2021; 44:e668-e674. [PMID: 34590948 DOI: 10.3928/01477447-20210817-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic necessitated an unprecedented increase in the use of telehealth services in orthopedics. Patient attitudes toward and satisfaction with virtual orthopedic services remain largely unexplored. A prospective study of all orthopedic patients at a tertiary academic medical center who had a telehealth appointment between April 1, 2020, and May 5, 2020, was performed to assess patients' experience with a validated 21-item telehealth satisfaction questionnaire. The survey contained statements designed to assess patients' level of agreement with numerous aspects of telehealth, including convenience, the surgeon's ability to engage in care, ease of use, and future use of telehealth. Most respondents (86.7%) were satisfied with the telehealth system. The majority of patients expressed that the system is easy to use (90.0%), is convenient (86.7%), and saves them time (83.3%). Nearly all (95%) patients agreed that their surgeon could answer their questions with the use of this technology, although nearly half (46.6%) identified the lack of physical contact during the examination as problematic. Only 46.7% of patients agreed that telehealth should be a standard form of health care delivery in the future; these patients were found to have significantly longer commute times compared with those who did not (52.1±58.2 vs 28.3±19.2, P=.03). Patient perspectives on the widespread adoption of telehealth, such as ease of use, privacy protection, and convenience, showed that these anticipated barriers may be some of the greatest advantages of telehealth. The COVID-19 pandemic may have provided the momentum for telehealth to become a mainstay of orthopedic health care delivery in the future. [Orthopedics. 2021;44(5):e668-e674.].
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Ajrawat P, Young Shin D, Dryan D, Khan M, Ravi B, Veillette C, Leroux T. The Use of Telehealth for Orthopedic Consultations and Assessments: A Systematic Review. Orthopedics 2021; 44:198-206. [PMID: 34292815 DOI: 10.3928/01477447-20210621-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) pandemic, tele-health for orthopedic care is expanding rapidly. The authors sought to identify the evidence describing the effectiveness, barriers, and clinical applications of telehealth for orthopedic assessments and consultations. MEDLINE, PubMed, EMBASE, and the Cochrane Library were searched from inception to March 2020. Forty-seven studies were included, with the most common conditions evaluated being trauma related and the primary modality being videoconferencing. Available literature supports the use of telehealth for orthopedic consultations and assessments because it yields moderate-to-high patient and provider satisfaction, accurate examinations, cost-effectiveness, and reduced wait times. Most commonly reported concerns were professional liability, network security, and technical issues. Given the COVID-19 pandemic, rapid implementation and uptake of virtual assessment for patient care has occurred. The current evidence suggests that telehealth is capable of providing prompt access to quality, cost-efficient orthopedic consultations and assessments. [Orthopedics. 2021;44(4):198--206.].
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Jones RB, Hubble S, Taylor L, Gunn H, Logan A, Rowland T, Bradwell H, Connolly LJ, Algie K, Anil K, Halliday B, Houston S, Dennett R, Chatfield S, Buckingham S, Freeman J. Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study. JMIRX MED 2021; 2:e30233. [PMID: 37725550 PMCID: PMC10414296 DOI: 10.2196/30233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND Understanding and assessing patients' body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. OBJECTIVE The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. METHODS We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed "Up & Go," Berg Balance Test, ankle range of motion, shoulder range of motion) as the "challenge" for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers' family members and clinical experience. RESULTS Kubi, which allowed the clinician to remotely control the patient's device, was useful for repositioning the tablet camera to gain a better view of the patient's body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. CONCLUSIONS Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient's clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.
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Affiliation(s)
- Ray B Jones
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Suzanne Hubble
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Lloyd Taylor
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Hilary Gunn
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Angela Logan
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Tim Rowland
- Royal Cornwall Hospital Trust, Truro, United Kingdom
| | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Luke J Connolly
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Kim Algie
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Krithika Anil
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Bradley Halliday
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | | | - Rachel Dennett
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | | | - Sarah Buckingham
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Jennifer Freeman
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
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Gilbert AW, May CR, Brown H, Stokes M, Jones J. A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations. Arch Physiother 2021; 11:20. [PMID: 34488898 PMCID: PMC8419808 DOI: 10.1186/s40945-021-00115-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC. METHODS A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference. RESULTS Eight F2F and 5 VC participants were included. Shorter appointments were less 'worth' travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive. CONCLUSIONS This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration, North Thames, London, UK.
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hazel Brown
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, UCL, London, UK
| | - Maria Stokes
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, Wessex, UK
- Southampton NIHR Biomedical Research Centre, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Kellish AS, Hakim A, Shahi A, Gutowski CJ, Kleiner MT. The Delivery of Orthopaedic Care midst COVID-19 and Social Distancing. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:371-378. [PMID: 34423083 PMCID: PMC8359650 DOI: 10.22038/abjs.2020.48498.2406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/07/2020] [Indexed: 11/06/2022]
Abstract
In this paper we present the findings of a literature review covering articles published in the last three decades describing the application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articles studying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, and provide an example of our single urban level-1 trauma center's strategy for incorporating telemedicine into the clinical practice of orthopaedic surgeons during the COVID-19 pandemic.
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Affiliation(s)
- Alec S. Kellish
- Cooper Medical School of Rowan University, Camden New Jersey, USA
| | - Abraham Hakim
- Cooper Medical School of Rowan University, Camden New Jersey, USA
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Jenkins JM, Halai M. CORR Synthesis: What Evidence Is Available for the Continued Use of Telemedicine in Orthopaedic Surgery in the Post-COVID-19 Era? Clin Orthop Relat Res 2021; 479:747-754. [PMID: 33724978 PMCID: PMC8083835 DOI: 10.1097/corr.0000000000001444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Joanne M Jenkins
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
| | - Mansur Halai
- J. M. Jenkins, Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
- J. M. Jenkins, University of Glasgow, UK
- M. Halai, Department of Orthopaedics, University of Toronto, Canada
- M. Halai, Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
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Abstract
PURPOSE Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in orthopedics in these procedures has increased significantly. The aim of this systematic review was to find out to what extent there is scientific evidence for the use of telemedicine in the orthopedic field. METHODS A systematic literature search was carried out in various databases on randomized controlled trials (RCTs) on telemedical applications in orthopedics. RESULTS Altogether, 14 articles were identified that reported about a total of eight RCTs of telemedical applications in orthopedics. Two RCTs were about a patient-to-doctor video consultation and six RCTs were about telerehabilitation after knee and hip arthroplasty (4 × knee arthroplasty, one hip and knee arthroplasty, one hip arthroplasty). For the majority of outcome parameters evaluated, there were no significant differences between the study groups. The cost effectiveness of videoconsultations depended on the workload (number of patient consultations) as well as the effectiveness of telerehabilitation on the distance of the patient's home to the health care center (30 km round-trip). CONCLUSION There is sufficient evidence to recommend the use of telemedical methods in orthopedics. However, more research is necessary to further expand the possibilities of telemedical methods with regard to physical examination.
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Jaenisch M, Kohlhof H, Touet A, Kehrer M, Cucchi D, Burger C, Wirtz DC, Welle K, Kabir K. Evaluation of the Feasibility of a Telemedical Examination of the Hip and Pelvis - Early Lessons from the COVID-19 Pandemic. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:39-46. [PMID: 33327028 PMCID: PMC8043596 DOI: 10.1055/a-1289-0779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction
Due to the current COVID-19 pandemic, the German Health Ministry has issued restrictions applying to the field of orthopaedics and trauma surgery. Besides postponement of elective surgeries, outpatient consultations have been drastically reduced. Parallel to these developments, an increase in telemedical consultations has reflected efforts to provide sufficient patient care. This study aims to evaluate the feasibility of a clinical examination of the hip joint and pelvis by way of a telemedical consultation.
Materials and Methods
Twenty-nine patients of a German university clinic were recruited and assessed in both telemedical and conventional examinations. Agreement between the two examinations was then assessed, and connections between the observed agreement and patient-specific factors such as age, BMI and ASA classification were investigated.
Results
The inspections agreed closely with a mean Cohenʼs kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohenʼs kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohenʼs kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohenʼs kappa of 0.36 ± 0.19. A significant positive correlation was observed between the number of deviations in the different examinations and age (p = 0.05), and a significant positive correlation was shown between the number of non-feasible examinations and age (p < 0.01), BMI (p < 0.01) and ASA classification score (p < 0.01).
Discussion
Inspection and function can be reliably evaluated, whereas the significance of palpation, provocation and measurement of range of motion is limited. The small sample size puts limitations on the significance of a statistically relevant correlation between patient-specific factors such as age, BMI and ASA classification score and valid and successful implementation of a telemedical examination. The authors recommend targeted patient selection. If, however, patients are being evaluated who are very old (> 75 years), obese (BMI > 30) or with multiple comorbidities (ASA 3 and above), caution is advised. Large, prospective studies are needed in the future to fully validate telemedical consultations in the fields of orthopaedics and trauma surgery.
Conclusion
A telemedical examination of the hip joint and pelvis can be performed with certain limitations. Patient-specific factors such as age, BMI, and extent of comorbidities appear to have a relevant impact on validity and execution of the examination. Patients with multiple comorbidities (ASA 3 and above), advanced age (> 75 years) or obesity (BMI > 30) should, whenever possible, be examined in a conventional outpatient setting.
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Affiliation(s)
- Max Jaenisch
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Hendrik Kohlhof
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Amadeo Touet
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Michael Kehrer
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Davide Cucchi
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Christof Burger
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Dieter Christian Wirtz
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Kristian Welle
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
| | - Koroush Kabir
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
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Rizzi AM, Polachek WS, Dulas M, Strelzow JA, Hynes KK. The new 'normal': Rapid adoption of telemedicine in orthopaedics during the COVID-19 pandemic. Injury 2020; 51:2816-2821. [PMID: 32951916 PMCID: PMC7493795 DOI: 10.1016/j.injury.2020.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Telemedicine provides a safe and effective means for the delivery of care by physicians amongst many subspecialties. Historically, orthopaedic practices in the United States have not widely utilized telemedicine for the delivery of orthopaedic care. As technology improves the adoption and utilization of telemedicine will likely grow, especially in light of the novel coronavirus (COVID-19) pandemic. Our study aims to assess patient and surgeon satisfaction and efficacy of telemedicine during a rapid adoption due to the global pandemic. METHODS All patients who completed a telemedicine encounter (telephone or video) with an orthopaedic surgeon were contacted. Patients were individually contacted after their visit, and a standardized validated post-visit satisfaction survey was completed. Orthopaedic surgeons completed a standardized post-encounter survey after each visit. Pre-COVID-19 patient satisfaction data was used for comparison. RESULTS Orthopaedic surgeons completed 612 telehealth encounters either via phone or video consultation between April 6, 2020 and May 22, 2020. 95% of patients rated both surgeon sensitivity to their needs and response to their concerns as 'good' or 'very good.' 93% of patients reported they would participate in a telemedicine encounter again. Surgeons reported high satisfaction with telemedicine encounters (80%, 86% phone and video respectively), and that 78.4% of the time a telemedicine encounter was successful in replacing an in-person visit. CONCLUSION Patients and orthopaedic surgeons documented high levels of satisfaction with telehealth encounters during the novel coronavirus (COVID-19) pandemic. Telemedicine does not appear to be a replacement for all in-person clinic encounters, however, when used in the appropriate context demonstrated favourable results. LEVEL OF EVIDENCE Level 4 Study.
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Affiliation(s)
- Andrew M Rizzi
- University of Chicago Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL, 60637, USA.
| | - William S Polachek
- University of Chicago Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL, 60637, USA
| | - Matthew Dulas
- University of Chicago Pritzker School of Medicine, 5841 South Maryland Ave, Chicago, USA
| | - Jason A Strelzow
- University of Chicago Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL, 60637, USA
| | - Kelly K Hynes
- University of Chicago Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Chicago, IL, 60637, USA
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Fiani B, Siddiqi I, Lee SC, Dhillon L. Telerehabilitation: Development, Application, and Need for Increased Usage in the COVID-19 Era for Patients with Spinal Pathology. Cureus 2020; 12:e10563. [PMID: 33101809 PMCID: PMC7577310 DOI: 10.7759/cureus.10563] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has triggered governments worldwide to implement severe restrictions on physical therapy protocols in order to better control the spread of the virus. One of the mechanisms of providing physical therapy patient care during this era is via telemedicine. Telerehabilitation or telerehab is a technological visual-audio system that serves patients, including those with a spine injury, ailment, or postoperatively, with neurological deficits. In this scoping review, we discuss the development of telerehab, the technological advances in the field, and the usage of telerehab specifically pertaining to spine patients, and comment on the advancement of telerehab in the time of COVID-19. There is preliminary evidence that suggests that the adoption of telerehab in lieu of face-to-face interventions is beneficial for reducing pain and improving physical function in patients afflicted with chronic nonmalignant musculoskeletal pain from low back pain, lumbar stenosis, neck pain, and osteoarthritis. Availability is important, as the necessary technology should be accessible to all participants. Safety and security should be addressed, as the passage of patient data over the Internet requires secure confidentiality. Ease-of-use is crucial to promote practicality, user-friendly operation, and adherence to therapy. The combination of evidence-based methodologies with cost-effective services will serve as a basis for the further expansion of vital telerehab services and increases reimbursement by health insurance providers.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Imran Siddiqi
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Sharon C Lee
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
| | - Lovepreet Dhillon
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, USA
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