ABSTRACT
Purpose of Study The COVID-19 pandemic required rapid, global healthcare shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopedic surgeons during this time. We aimed to investigate COVID-19 related changes in practice, training, and research among pediatric orthopedic surgeons globally. Methods Used An online, cross-sectional survey was administered to orthopedic surgeons with interest in pediatrics in April 2020. The survey captured demographics and selfreported experiences during the pandemic. Surgeons were recruited through web media and email lists of orthopaedic societies over 2 months. Descriptive statistics were used to analyze results. Summary of Results We received 460 responses from 45 countries. 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported reduction in average number of surgeries per week, from 6.89 (SD=4.61) pre-pandemic to 1.25 (SD=2.26) at time of survey (mean difference= 5.64;95% CI=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) pre-pandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% CI: 5.61, 60.58). 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported systems to continue training. Of 192 surgeons with research, 149 (82.8%) reported continuing research activities during pandemic. Most reported cessation (n=75, 64.1%) or reduction (n=40, 34.1%) in patient recruitment at time of survey. Conclusions We found significant impacts on pediatric orthopaedic practice with uptake of technology to provide care continuity. Understanding global impacts can inform sustainable practices to provide continuity in future disruptions. We will pursue follow-up surveys to assess longitudinal impacts on surgeons. Epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.
ABSTRACT
Background and Objective(s): Coronavirus disease-2019 (COVID-19) led to the suspension of in-person therapy sessions in March 2020 in British Columbia (BC), Canada. This necessitated the use of virtual visits, defined as face-to-face consultation completed remotely. Here we report the assessment of pediatric physical therapists and occupational therapists use of virtual visits, barriers to virtual care, and their perceived impact on completion of community-based hip surveillance during the COVID-19 pandemic. Study Design: Cross-sectional survey. Study Participants & Setting: All pediatric therapists in the province were invited to participate. The survey was emailed to approximately 130 therapists in June 2020 using known email distribution lists. Therapists were asked to forward the survey to colleagues. Materials/Methods: An anonymous online survey assessing therapists' knowledge and learning needs related to hip surveillance was completed as part of continuous quality improvement for the Child Health BC Hip Surveillance Program for Children with Cerebral Palsy. Questions related to the provision of virtual visits during the COVID-19 pandemic were included in this survey. Therapists were also asked to rate their confidence and satisfaction in using virtual visits, identify barriers to virtual visits, and the impact of virtual visits on completing community based hip surveillance. Results: The survey was completed by 64 participants (60 physical therapists, 1 occupational therapist, 3 duel trained). Respondents were from varied practice settings: 48% metro, 30% urban, 19% rural and 3% remote. Prior to the pandemic, 6% (4) of respondents reported using virtual health with 5% (3) reporting being very confident and 22% (14) confident in using healthcare technology. Since the start of the pandemic, 86% (55) of therapists have been providing virtual visits. Eight different platforms for these visits were identified. Of those providing virtual visits, 44% were satisfied/very satisfied with their experience in providing virtual care. Barriers to providing virtual care included families not being familiar with the virtual platforms (35), not wanting to be seen virtually (34), or being able to afford technology (26) and lack of wireless internet or poor connection (19). Additionally, therapists identified completing a physical assessment (12), privacy and security concerns (9), engaging the child and family (6), and their own learning needs related to using virtual care (3) as barriers. When asked how the pandemic would affect their practice related to hip surveillance, 65% (40) reported completion of the clinical exam would be affected while 25% (16) felt identifying children that require surveillance would be impacted. The most requested resources to support virtual visits were improved access to virtual platforms and online technology tools. Conclusions/Significance: Therapists rapidly switched to using virtual healthcare due to the COVID-19 pandemic. Less than half were satisfied with their experience. Reported barriers to virtual care suggest virtual visits are not always easily accessible for families. Practical tools and strategies to facilitate access to continuing care are required when virtual visits are required.