Teleconsultation in orthopaedic surgery: A systematic review and meta-analysis of patient and physician experiences

Abstract

Introduction The primary purpose of this review was to evaluate patient and physician preference and satisfaction for teleconsultation in orthopaedic surgery compared to traditional face-to-face consultation. In addition, we evaluated the effects of teleconsultation on patient length of visit, healthcare costs, range of motion (ROM), pain, quality of life (QOL), and ongoing management plans. Methods A systematic review of MEDLINE, Embase, Web of Science, and Cochrane Library was conducted according to PRISMA guidelines. Randomised control trials and case control studies comparing teleconsultation with traditional, face-to-face consultation in the management of orthopaedic conditions were included. The primary outcome measures were patient and physician preference and satisfaction. Secondary outcomes included patient length of visit, healthcare costs, ROM, pain, QOL, and ongoing management plans. Results A total of 13 articles meeting the eligibility criteria were included for systematic review and 8 for meta-analysis. There was no significant difference in patient satisfaction, length of visit, or time spent with the physician between the telemedicine and in-office control group. The mean difference of patient preference for telemedicine was significantly higher in the telemedicine group compared to the in-office visit group (OR 1.44, 95% CI 1.12–1.87, p = 0.005). Discussion Telemedicine was not inferior to face-to-face office visits in regard to patient and physician preference and satisfaction. Therefore, it would be an effective adjunct to face-to-face office visits, serving as a mechanism of triage and long-term continuity of care.

Teleconsultation in the Management of Elective Orthopaedic and Spinal Conditions During the COVID-19 Pandemic

“…We assess patient preference, satisfaction, and duration of consultation, and predict that teleconsultation is comparable to in-person consultation in these regards. Consistent with the literature, we also hypothesize that rst-hand exposure to teleconsultation will positively in uence a patient's preference for its use in the future [7].…”

“…A strong patient-provider relationship enhances patient satisfaction and improves compliance, as well as improving overall health outcomes [6]. In a recent systematic review and meta-analysis, we demonstrated that teleconsultation was not inferior to traditional face-to-face o ce visits in regard to patient and physician preference and satisfaction [7]. In fact, we found that patients who utilized teleconsultation were roughly 1.5 times more likely to prefer it for subsequent appointments over traditional o ce visits, indicating a role for such technologies post-COVID.…”

Good Comes From Evil: COVID-19 and the Advent of Telemedicine in Orthopedics

“…However, some studies have suggested that telemedicine visits can result in additional testing being ordered when compared with in-person visits [23,64]. In a recent systematic review of telemedicine in orthopedics, 12 of 13 included studies reported no significant difference in patient satisfaction with telemedicine compared with in-person office visits, along with a reduction in health care–associated costs with telemedicine [41]. In fact, 1 study demonstrated increased patient satisfaction with telemedicine visits which was attributed to shorter wait times [23,64].…”

“…Previously published studies on telemedicine in orthopedics prior to the COVID-19 pandemic demonstrated that most remote patient interactions were actually asynchronous, with patients sending images of wounds or representative photos of joint range of motion to their provider for interpretation and guidance [8,17,26,32]. More recent advances in web-based videoconferencing platforms have allowed for synchronous, real-time remote interactions, facilitating a more personal approach to patient encounters that more closely resemble traditional in-person visits [41].…”

“…Despite its devastating consequences across the globe, the COVID-19 pandemic has served as a catalyst for the widespread expansion of telemedicine [3]. While telemedicine will not entirely replace in-person orthopedic care, it can offer advantages including cost-effectiveness, safety, convenient access, and high patient satisfaction [5,41,60]. Barriers to widespread adoption include the limited availability of technology for some patients and the challenges in performing an adequate remote physical examination for clinicians.…”