Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial.

INTRODUCTION: Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations. METHODS: This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ). RESULTS: This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively (p = 0.42). DISCUSSION: We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.

Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial.

BACKGROUND: Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference. METHOD: We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed. RESULTS: Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. 'better') at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as 'good' or 'very good'. In the ancillary analyses, there was no significant difference between the two groups. CONCLUSIONS: This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00616837.

Displaced stress fracture of the femoral neck in young active adults.

Stress fractures of the femoral neck in healthy individuals are rare and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders and, thereby, following amenorrhoea and osteoporosis. The majority of fractures of the femoral neck are undisplaced. However, they might progress into displaced fractures with avascular necrosis of the femoral head and following development of osteoarthritis as a probable consequence even when treated properly. Early diagnosis with MRI or radionuclide scanning in patients with a history of pain in the groin region during training might be crucial in detecting the fractures at early stages; thereby preventing possible complications following surgical treatment of displaced fractures. The authors present a report of two young adults who developed displaced fractures of the femoral neck and were treated with closed reduction and internal fixation.

Operating time and survival of primary total hip replacements: an analysis of 31,745 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register 1987-2001.

BACKGROUND: Some studies have found a significant decrease in operating time as a result of standardizing programs for hip surgery. To study the influence of operating time (skin to skin) on survival of total hip replacements, we investigated the operating time in local hospitals in Norway. We have found no other large published series of THRs investigating operating time and revision. PATIENTS AND METHODS: The study was based on 31,745 primary THRs reported to the Norwegian Arthroplasty Register from 47 local hospitals during 1987-2001. Operating time was divided into 7 categories, and for each category separate Kaplan-Meier curves and adjusted failure rate ratios were calculated. RESULTS: The mean operating time for all local hospitals in Norway was 96 (68-130) min. Increasing operating volume from less than 10 THRs/hospital/year to more than 200 THRs/hospital/year was associated with a 25-min decrease in mean operating time in cemented THRs and a 35-min decrease in the case of uncemented THRs. With the operating time category of 71-90 min as reference category, cemented THRs that lasted more than 150 min had a two-fold increased (95% CI: 1.6-2.6) revision rate. For uncemented implants, the revision rate was 1.3 times higher (95% CI: 0.8-2.2). Cemented implants with operating time under 51 min and over 90 min were associated with an increased risk of revision due to aseptic loosening. Cemented implants with operating time over 150 min were associated with an increased risk of revision due to infection. INTERPRETATION: Hospitals with long operating times should consider the potential benefit of reducing these times, as this may lead to lower revision rates and increased operating volumes. Shorter operation times could be achieved by standardization programs, but one should bear in mind that for cemented implants very short operating times also increased revision risk due to aseptic loosening.