Telemedicine for pediatric orthopedic visits: evaluating usability and satisfaction

Abstract

The purpose of this study is to evaluate usability and patient satisfaction with telemedicine in pediatric orthopedics using validated questionnaires and to identify demographic and clinical factors that may impact these ratings. All caregivers of patients who had telemedicine visits with a single fellowship-trained pediatric orthopedic surgeon between 23 March 2020 and 3 June 2020 were eligible to participate. Patient Satisfaction Questionnaire (PSQ) and the Telehealth Usability Questionnaire (TUQ) rated on a 4-point Likert scale (1 = poor, 2 = fair, 3 = good and 4 = excellent) were used. Additional information regarding the level of education, mode of transportation, technology usage, demographics, visit diagnosis and length of visit were collected. Quantitative analysis was performed. A total of 68.6% (83/121) of the visits were done via telemedicine. Around 46 surveys were completed with a response rate of 55.4% (46/83). The PSQ mean score was 3.63 ± 0.39 with non-English-speaking caregivers scoring lower compared to their Englishspeaking counterparts (3.4 ± 0.47 vs. 3.72 ± 0.33; P = 0.017). PSQ mean score increased with increasing length of visit (r = 0.352; P = 0.018). A total of 86.8% (839/966) of all TUQ's responses were good to excellent with 89.1% (41/46) of responders were satisfied with telemedicine and 91.3% (42/46) would use it again. Although the topic is an evolving one, and a lot of changes should be expected in the future, certain characteristics such as primary language and length of visit may affect the levels of satisfaction with the use of telemedicine in pediatric orthopedics. Knowledge regarding satisfaction ratings may allow orthopedic surgeons to improve patient care delivered through this technology. Level of Evidence: IV.

Factors That Foster Therapeutic Alliance in Pediatric Sports and Orthopedics: A Systematic Review

“…Seven of the eleven included studies are cross-sectional study designs [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ], one study is a qualitative study [ 26 ], one is a case report [ 27 ], one study is a randomized prospective design [ 28 ], and one is a prospective cohort design [ 29 ]. Table 1 and Table 2 includes data extracted from these included studies.…”

“…No studies examined the differences of therapeutic alliance factors among healthcare providers in the pediatric sports and orthopedics population. Two of the articles focused on factors associated with physical therapists [ 26 , 27 ], two were focused on the orthopedic care team as a whole [ 22 , 24 ], five focused on factors associated with physicians [ 19 , 21 , 23 , 28 , 29 ], and two focused on factors associated specifically with surgeons [ 20 , 25 ]. Very few differences were found among healthcare disciplines.…”

“…Three included studies examined the association of therapeutic alliance in telehealth visits vs. in-person visits [ 21 , 25 , 28 ]. Therapeutic alliance scores, measured by the Therapeutic Alliance Scale for Children-Revised (TASC-R), were not statistically different for adolescent patients with concussions in the in-person or telehealth setting [ 28 ].…”

“…Hanna et al [ 25 ] described patient satisfaction in telehealth. They found that a higher patient satisfaction score was positively correlated with the length of the telemedicine visit, particularly visits that lasted more than 30 min compared to visits that lasted less than 30 min ( p < 0.0001).…”

“…Three of our included studies examined the association of therapeutic alliance with telehealth visits compared to in-person visits [ 21 , 25 , 28 ]. Telehealth visits have increased drastically in popularity during the COVID-19 pandemic due to increased exposure to sickness, recent business shut-downs, and transportation challenges [ 21 , 25 , 28 , 40 ]. Our study found that telehealth visits still foster therapeutic alliance among patients and parents compared to in-person visits.…”