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Evaluation of the Feasibility of a Telemedical Examination of the Hip and Pelvis – Early Lessons from the COVID-19 PandemicArticle in several languages: English | deutsch
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 and Methods 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 Cohenʼs kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohenʼs kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohenʼs kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohenʼs 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.
* equally contributing first authors
** equally contributing last authors
Article published online:
16 December 2020
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- 1 Zhu N, Zhang D, Wang W. et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733 doi:10.1056/NEJMoa2001017
- 2 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395: 565-574 doi:10.1016/S0140-6736(20)30251-8
- 3 Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed 2020; 91: 157-160 doi:10.23750/abm.v91i1.9397
- 4 Tian H, Liu Y, Li Y. et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science 2020; 368: 638-642 doi:10.1126/science.abb6105
- 5 Bundesministerium für Gesundheit. Coronavirus SARS-CoV-2 (11.03.2020). Im Internet (Stand: 10.09.2020): http://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html
- 6 U.S. Centers for Medicare & Medicaid Services. Telehealth services (01.02.2020). Im Internet (Stand: 10.09.2020): http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
- 7 Lurie N, Carr BG. The Role of Telehealth in the Medical Response to Disasters. JAMA Intern Med 2018; 178: 745-746 doi:10.1001/jamainternmed.2018.1314
- 8 Buvik A, Bugge E, Knutsen G. et al. Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial. BMC Health Serv Res 2016; 16: 483 doi:10.1186/s12913-016-1717-7
- 9 The White House. President Trump and Secretary Shulkin Announce Veteran Telehealth Initiatives (03.08.2017). Im Internet (Stand: 10.09.2020): https://www.whitehouse.gov/articles/president-trump-secretary-shulkin-announce-veteran-telehealth-initiatives/
- 10 Maia MR, Castela E, Pires A. et al. How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on – an exploratory study. BMC Health Serv Res 2019; 19: 681 doi:10.1186/s12913-019-4511-5
- 11 Tchero H, Kangambega P, Briatte C. et al. Clinical Effectiveness of Telemedicine in Diabetes Mellitus: A Meta-Analysis of 42 Randomized Controlled Trials. Telemed J E Health 2019; 25: 569-583 doi:10.1089/tmj.2018.0128
- 12 Buvik A, Bergmo TS, Bugge E. et al. Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial. J Med Internet Res 2019; 21: e11330 doi:10.2196/11330
- 13 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
- 14 Scott KL, Skotak CM, Renfree KJ. Remote Assessment of Wrist Range of Motion: Inter- and Intra-Observer Agreement of Provider Estimation and Direct Measurement with Photographs and Tracings. J Hand Surg Am 2019; 44: 954-965 doi:10.1016/j.jhsa.2019.05.017
- 15 Dent PA, Wilke B, Terkonda S. et al. Validation of Teleconference-based Goniometry for Measuring Elbow Joint Range of Motion. Cureus 2020; 12: e6925 doi:10.7759/cureus.6925
- 16 Mani S, Sharma S, Omar B. et al. Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review. J Telemed Telecare 2016; 23: 379-391 doi:10.1177/1357633X16642369
- 17 Loeb AE, Rao SS, Ficke JR. et al. Departmental Experience and Lessons Learned With Accelerated Introduction of Telemedicine During the COVID-19 Crisis. J Am Acad Orthop Surg 2020; 28: e469-e476 doi:10.5435/JAAOS-D-20-00380
- 18 Rao SS, Loeb AE, Amin RM. et al. Establishing Telemedicine in an Academic Total Joint Arthroplasty Practice: Needs and Opportunities Highlighted by the COVID-19 Pandemic. Arthroplast Today 2020; 6: 617-622 doi:10.1016/j.artd.2020.04.014
- 19 Tanaka MJ, Oh LS, Martin SD. et al. Telemedicine in the Era of COVID-19: The Virtual Orthopaedic Examination. J Bone Joint Surg Am 2020; 102: e57 doi:10.2106/JBJS.20.00609
- 20 Parkes RJ, Palmer J, Wingham J. et al. Is virtual clinic follow-up of hip and knee joint replacement acceptable to patients and clinicians? A sequential mixed methods evaluation. BMJ Open Qual 2019; 8: e000502 doi:10.1136/bmjoq-2018-000502
- 21 Holderried M, Schlipf M, Höper A. et al. Chancen und Risiken der Telemedizin in der Orthopädie und Unfallchirurgie. Z Orthop Unfall 2017; 156: 68-77 doi:10.1055/s-0043-116941
- 22 Vesterby MS, Pedersen PU, Laursen M. et al. Telemedicine support shortens length of stay after fast-track hip replacement. Acta Orthop 2016; 88: 1-7 doi:10.1080/17453674.2016
- 23 Tsvyakh AI, Hospodarskyy AJ. Telerehabilitation of Patients with Injuries of the Lower Extremities. Telemed J E Health 2017; 23: 1011-1015 doi:10.1089/tmj.2016.0267