ABSTRACT
INTRODUCTION The purpose of surveillance after resection of colorectal liver metastases (CLM) is to detect and treat recurrence using axial imaging, biomarker measurement, and a history/physical examination. In response to COVID-19 pandemic, telemedicine was used as a risk mitigation strategy to replace in-person visits, including for cancer surveillance. The objective of the study was to measure the uptake of telemedicine for cancer surveillance and outcomes following telemedicine surveillance after resection of CLM. METHODS Data from a prospective database was combined with real world data obtained from electronic health records using a cloud-based, data integration tool (Palantir Foundry) to identify patients in active surveillance following first surgical resection for CLM between April 2017 and April 2021. Telemedicine surveillance visit was defined as a follow-up visit >90 days following surgery using video or telephone. Recurrence was defined as detection of a new lesion. Bivariate statistical testing was performed using Student's t-test or chi-squared test. Retrospective chart review was used to validate identification of recurrence using the Foundry platform (100% interobserver agreement). RESULTS A total of 1,057 surveillance visits (306 patients) met our inclusion criteria. Prior to April 2020, 0% (0/686) visits utilized telemedicine. After April 2020, an average of 47.3% of visits per month utilized telemedicine (range 33.0 – 69.0%). The overall rate of identifying a recurrence during surveillance visit was 18.1% (191/1,057). There was no difference when comparing detection of recurrence using in-person (17.6%, 154/872) versus telemedicine visits (20.0%, 37/185, P=.371). The management of recurrence did not differ whether it was identified with an in-person or telemedicine visit;surgery, 36 (23%) vs. 10 (27%);ablation, 26 (17%) vs. 8 (22%);systemic therapy, 83 (54%) vs. 16 (43%);other, 9 (6%) vs. 3 (8%), respectively (P=.699). CONCLUSION Telemedicine was used in almost half of surveillance visits for CLM during the COVID- 19 pandemic. Detection and treatment of recurrence was similar for both telemedicine and in-person visits. Telemedicine-based follow-up is a safe and effective approach for surveillance after resection of CLM, supporting continued utilization beyond the pandemic.
ABSTRACT
The health crisis caused by COVID-19 has had a huge impact on the provision of physiotherapists' services during the pandemic. Patellofemoral pain syndrome (PFPS) is a major health problem and one of the most common causes of pain in the front of the knee in outpatients. The objective was to evaluate the effectiveness of a therapeutic physical exercise (TPE) program supervised by a physiotherapist using telematic channels in reducing pain and disability in a sample of 54 patients with PFPS in the Physiotherapy Service of the San José de la Rinconada Health Center (Seville). Subjects were evaluated pre- and post-intervention (4 weeks-12 treatment sessions). An analysis was made of perceived pain-using the visual analog scale (VAS) and the DN4 neuropathic pain questionnaire-and functional balance-through the Kujala Score test and the Lower Extremity Functional Scale. The supervised TPE program in patients with PFPS produced a reduction in pain: VAS F1, 52 = 8.68 (p = 0.005) η2 = 0.14 and DN4: F1, 52 = 69.94 (p = 0.000) η2 = 0.57; and in Lower Extremity Functional Scale (LEFS) disability: F1, 52 = 19.1 (p = 0.000) η2 = 0.27 and KUJALA: F1, 52 = 60.28 (p = 0.000) η2 = 0.54, which was statistically significant (p = 0.000 for p < 0.05). Hence, the TPE program presented was effective in reducing pain and disability in patients with PFPS.