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How Satisfied Are Patients and Surgeons with Telemedicine in Orthopaedic Care During the COVID-19 Pandemic? A Systematic Review and Meta-analysis.
Chaudhry, Harman; Nadeem, Shaheer; Mundi, Raman.
  • Chaudhry H; H. Chaudhry, S. Nadeem, R. Mundi, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
  • Nadeem S; H. Chaudhry, S. Nadeem, R. Mundi, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
  • Mundi R; H. Chaudhry, S. Nadeem, R. Mundi, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Clin Orthop Relat Res ; 479(1): 47-56, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1483562
Semantic information from SemMedBD (by NLM)
1. Satisfaction PROCESS_OF Surgeon
Subject
Satisfaction
Predicate
PROCESS_OF
Object
Surgeon
2. Personal assessment ADMINISTERED_TO Orthopedic Surgeons
Subject
Personal assessment
Predicate
ADMINISTERED_TO
Object
Orthopedic Surgeons
3. Wounds and Injuries PROCESS_OF Adult
Subject
Wounds and Injuries
Predicate
PROCESS_OF
Object
Adult
4. Telemedicine ADMINISTERED_TO Patients
Subject
Telemedicine
Predicate
ADMINISTERED_TO
Object
Patients
5. Telemedicine METHOD_OF Orthopedic assessment
Subject
Telemedicine
Predicate
METHOD_OF
Object
Orthopedic assessment
6. Telemedicine TREATS Patients
Subject
Telemedicine
Predicate
TREATS
Object
Patients
7. Telemedicine TREATS Surgeon
Subject
Telemedicine
Predicate
TREATS
Object
Surgeon
8. Experience PROCESS_OF Patients
Subject
Experience
Predicate
PROCESS_OF
Object
Patients
9. Satisfaction PROCESS_OF Surgeon
Subject
Satisfaction
Predicate
PROCESS_OF
Object
Surgeon
10. Personal assessment ADMINISTERED_TO Orthopedic Surgeons
Subject
Personal assessment
Predicate
ADMINISTERED_TO
Object
Orthopedic Surgeons
11. Wounds and Injuries PROCESS_OF Adult
Subject
Wounds and Injuries
Predicate
PROCESS_OF
Object
Adult
12. Telemedicine ADMINISTERED_TO Patients
Subject
Telemedicine
Predicate
ADMINISTERED_TO
Object
Patients
13. Telemedicine METHOD_OF Orthopedic assessment
Subject
Telemedicine
Predicate
METHOD_OF
Object
Orthopedic assessment
14. Telemedicine TREATS Patients
Subject
Telemedicine
Predicate
TREATS
Object
Patients
15. Telemedicine TREATS Surgeon
Subject
Telemedicine
Predicate
TREATS
Object
Surgeon
16. Experience PROCESS_OF Patients
Subject
Experience
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 pandemic has resulted in a rapid pivot toward telemedicine owing to closure of in-person elective clinics and sustained efforts at physical distancing worldwide. Throughout this period, there has been revived enthusiasm for delivering and receiving orthopaedic care remotely. Unfortunately, rapidly published editorials and commentaries during the pandemic have not adequately conveyed findings of published randomized trials on this topic. QUESTIONS/

PURPOSES:

In this systematic review and meta-analysis of randomized trials, we asked (1) What are the levels of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care delivery? (2) Are there differences in patient-reported outcomes between telemedicine visits and in-person visits? (3) What is the difference in time commitment between telemedicine and in-person visits?

METHODS:

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review with the primary objective to determine patient and surgeon satisfaction with telemedicine, and secondary objectives to determine differences in patient-reported outcomes and time commitment. We used combinations of search keywords and medical subject headings around the terms "telemedicine", "telehealth", and "virtual care" combined with "orthopaedic", "orthopaedic surgery" and "randomized." We searched three medical databases (MEDLINE, Embase, and the Cochrane Library) in duplicate and performed manual searches to identify randomized controlled trials evaluating the outcomes of telemedicine and in-person orthopaedic assessments. Trials that studied an intervention that was considered to be telemedicine (that is, any form of remote or virtual care including, but not limited to, video, telephone, or internet-based care), had a control group that comprised in-person assessments performed by orthopaedic surgeons, and were reports of Level I original evidence were included in this study. Studies evaluating physiotherapy or rehabilitation interventions were excluded. Data was extracted by two reviewers and quantitative and qualitive summaries of results were generated. Methodological quality of included trials was assessed using the Cochrane Risk of Bias tool, which uniformly rated the trials at high risk of bias within the blinding categories (blinding of providers, patients, and outcome assessors). We screened 133 published articles; 12 articles (representing eight randomized controlled trials) met the inclusion criteria. There were 1008 patients randomized (511 to telemedicine groups and 497 to control groups). Subspecialties represented were hip and knee arthroplasty (two trials), upper extremity (two trials), pediatric trauma (one trial), adult trauma (one trial), and general orthopaedics (two trials).

RESULTS:

There was no difference in the odds of satisfaction between patients receiving telemedicine care and those receiving in-person care (pooled odds ratio 0.89 [95% CI 0.40 to 1.99]; p = 0.79). There were also no differences in surgeon satisfaction (pooled OR 0.38 [95% CI 0.07 to 2.19]; p = 0.28) or among multiple patient-reported outcome measures that evaluated pain and function. Patients reported time savings, both when travel time was excluded (17 minutes shorter [95% CI 2 to 32]; p = 0.03) and when it was included (180 minutes shorter [95% CI 78 to 281]; p < 0.001).

CONCLUSION:

Evidence from heterogeneous randomized studies demonstrates that the use of telemedicine for orthopaedic assessments does not result in identifiable differences in patient or surgeon satisfaction compared with in-person assessments. Importantly, the source studies in this review did not adequately capture or report safety endpoints, such as complications or missed diagnoses. Future studies must be adequately powered to detect these differences to ensure patient safety is not compromised with the use of telemedicine. Although telemedicine may lead to a similar patient experience, surgeons should maintain a low threshold for follow-up with in-person assessments whenever possible in the absence of further safety data. LEVEL OF EVIDENCE Level I, therapeutic study.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Orthopedics / Patient Satisfaction / Telemedicine / Orthopedic Procedures / COVID-19 / Job Satisfaction Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Clin Orthop Relat Res Year: 2021 Document Type: Article Affiliation country: CORR.0000000000001494

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Orthopedics / Patient Satisfaction / Telemedicine / Orthopedic Procedures / COVID-19 / Job Satisfaction Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Clin Orthop Relat Res Year: 2021 Document Type: Article Affiliation country: CORR.0000000000001494