Evaluation of the Feasibility of a Telemedical Examination of the Hip and Pelvis - Early Lessons from the COVID-19 Pandemic. / Evaluation der Durchführbarkeit einer telemedizinischen Untersuchung des Hüftgelenks und des Beckens frühe Lehren aus der COVID-19-Pandemie.
Z Orthop Unfall
; 159(1): 39-46, 2021 02.
Article
in English, German
| MEDLINE | ID: covidwho-978532
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 ANDMETHODS:
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 Cohen's kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohen's kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohen's kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohen's 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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pelvis
/
Physical Examination
/
Telemedicine
/
Pandemics
/
COVID-19
/
Hip Joint
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Aged
/
Humans
Language:
German
/
English
Journal:
Z Orthop Unfall
Journal subject:
Orthopedics
/
Traumatology
Year:
2021
Document Type:
Article
Affiliation country:
A-1289-0779
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