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INTRODUCTION: In response to the COVID-19 pandemic, telehealth has been rapidly implemented in outpatient services worldwide. However, little is known about the experiences of telehealth in a tertiary outpatient physiotherapy setting. OBJECTIVE: 1) describe the experience of physiotherapists and patients who utilized telehealth services in a tertiary health facility; and 2) identify the challenges and opportunities of physiotherapy service provision via telehealth in a tertiary health facility. METHODS: A mixed-methods approach was undertaken in the physiotherapy outpatient department between June and October 2020. Patients utilizing telehealth services were invited to complete a purposely designed survey. Physiotherapists completed the Telehealth Usability Questionnaire (TUQ) and provided open-ended responses. Descriptive analysis of quantitative data was completed and thematic analysis was used for qualitative data. RESULTS: Patients reported positive experiences with telehealth, with 93% finding it easy to use and 90% satisfied with the time it took to get an appointment. Scores on the TUQ by physiotherapists were highest for usefulness with a mean (SD) score of 6.02 (1.09), while lower scores were seen for reliability with a score of 3.24 (1.48). Five broad themes were identified: 1) connecting with patients during a pandemic; 2) keeping treatment on track; 3) unprepared for the technology challenges; 4) telehealth - not quite the real thing; and 5) better resources to facilitate moving forwards.While the overall patient experience was high, physiotherapist's satisfaction with telehealth was more varied. Additional work may be needed to improve the technical and logistical aspects of telehealth to support ongoing use in physiotherapy clinical practice.
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AIMS: COVID-19 represents one of the greatest global healthcare challenges in a generation. Orthopaedic departments within the UK have shifted care to manage trauma in ways that minimize exposure to COVID-19. As the incidence of COVID-19 decreases, we explore the impact and risk factors of COVID-19 on patient outcomes within our department. METHODS: We retrospectively included all patients who underwent a trauma or urgent orthopaedic procedure from 23 March to 23 April 2020. Electronic records were reviewed for COVID-19 swab results and mortality, and patients were screened by telephone a minimum 14 days postoperatively for symptoms of COVID-19. RESULTS: A total of 214 patients had orthopaedic surgical procedures, with 166 included for analysis. Patients undergoing procedures under general or spinal anaesthesia had a higher risk of contracting perioperative COVID-19 compared to regional/local anaesthesia (p = 0.0058 and p = 0.0007, respectively). In all, 15 patients (9%) had a perioperative diagnosis of COVID-19, 14 of whom had fragility fractures; six died within 30 days of their procedure (40%, 30-day mortality). For proximal femoral fractures, our 30-day mortality was 18.2%, compared to 7% in 2019. CONCLUSION: Based on our findings, patients undergoing procedures under regional or local anaesthesia have minimal risk of developing COVID-19 perioperatively. Those with multiple comorbidities and fragility fractures have a higher morbidity and mortality if they contract COVID-19 perioperatively; therefore, protective care pathways could go some way to mitigate the risk. Our 30-day mortality of proximal femoral fractures was 18.2% during the COVID-19 pandemic in comparison to the annual national average of 6.1% in 2018 and the University Hospital Coventry average of 7% for the same period in 2019, as reported in the National Hip Fracture Database. Patients undergoing procedures under general or spinal anaesthesia at the peak of the pandemic had a higher risk of contracting perioperative COVID-19 compared to regional block or local anaesthesia. We question whether young patients undergoing day-case procedures under regional block or local anaesthesia with minimal comorbidities require fourteen days self-isolation; instead, we advocate that compliance with personal protective equipment, a negative COVID-19 swab three days prior to surgery, and screening questionnaire may be sufficient.Cite this article: Bone Joint Open 2020;1-9:520-529.