The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

Satin, Alexander M.; Lieberman, Isador H.

doi:10.1177/2192568220947744

Cited by 39 publications

(55 citation statements)

References 33 publications

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“…External forces limiting in-person evaluations forced orthopaedic providers to carve out a novel role for telemedicine in the pre-operative assessment of patients, and challenged the perceptions of many patients, providers, and healthcare systems. Specifically, much of the literature thus far has focused on the use and validity of various virtual physical exam manoeuvres [ 5 – 10 ]. However, given the significant breakthroughs in advanced imaging, technology, and communications systems, it is not clear that the physical exam itself is as important as it once was for most orthopaedic diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…The primary limitation of telemedicine is the inability to perform a traditional in-person physical examination, which has long been taught to be paramount to the accurate diagnosis and treatment of musculoskeletal pathologies. As such, much of the recent clinical telemedicine literature within orthopaedics has focused on addressing and adapting to this limitation, with innovative virtual alternatives to traditional exams [ 5 – 10 ]. Nonetheless, these virtual exams have yet to be validated and standardised.…”

Section: Introductionmentioning

confidence: 99%

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Telemedicine visits generate accurate surgical plans across orthopaedic subspecialties

Crawford

Lightsey

Xiong

et al. 2021

Arch Orthop Trauma Surg

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Introduction The role of telemedicine is rapidly evolving across medical specialties and orthopaedics. The utility of telemedicine to identify operative candidates and determine surgical plans has yet to be demonstrated. We sought to assess whether surgical plans proposed following telemedicine visits changed after subsequent in-person interaction across orthopaedic subspecialties. Materials and methods We identified all elective telemedicine encounters across two academic institutions from March 1, 2020 to July 31, 2020. We identified patients indicated for surgery with a specific surgical plan during the virtual visit. The surgical plans delineated during the telemedicine encounter were then compared to final pre-operative plans documented following subsequent in-person evaluation. Changes in the surgical plan between telemedicine and in-person encounters were defined using a standardised schema. Regression analysis was used to evaluate factors associated with a change in surgical plan between visits across specialties, including the number of virtual examination manoeuvres performed. Results We identified 303 instances of a patient being indicated for orthopaedic surgery during a telemedicine encounter. In 11 cases (4%), the plan was changed between telemedicine and subsequent in-person encounter. No plans were changed amongst patients indicated for joint arthroplasty and foot and ankle surgery, whilst 4% of plans were changed amongst sports surgery and upper extremity/shoulder surgery. Surgical plans had the highest rate of change amongst spine surgery patients (8%). There was notable variability in the conduct of virtual examinations across subspecialties. Conclusion Our results demonstrate the capability of telemedicine to support development of accurate surgical plans for orthopaedic patients across several subspecialties. Our findings also highlight the substantial variation in the utilisation of physical examination manoeuvres conducted via telemedicine across institutions, subspecialties, and providers. Description of study type Level IV, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Telemedicine visits generate accurate surgical plans across orthopaedic subspecialties

Crawford

Lightsey

Xiong

et al. 2021

Arch Orthop Trauma Surg

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“…Our results showed that the most substantial challenge was the decreased ability to perform the physical examination, with nearly 40% of respondents highlighting this issue. Recent manuscripts have sought to address this challenge by publishing guidelines how to conduct effective virtual spine examinations [13,16]. Additionally, efforts to enhance the telemedicine appointment-such as providing instructions for patients prior to the visit on camera/body positioning, clothing, and setting-have shown to increase telemedicine efficiency [17,18].…”

Section: Challengesmentioning

confidence: 99%

Spine surgeon perceptions of the challenges and benefits of telemedicine: an international study

et al. 2021

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Introduction While telemedicine usage has increased due to the COVID-19 pandemic, there remains little consensus about how spine surgeons perceive virtual care. The purpose of this study was to explore international perspectives of spine providers on the challenges and benefits of telemedicine. Methods Responses from 485 members of AO Spine were analyzed, covering provider perceptions of the challenges and benefits of telemedicine. All questions were optional, and blank responses were excluded from analysis. Results The leading challenges reported by surgeons were decreased ability to perform physical examinations (38.6%), possible increased medicolegal exposure (19.3%), and lack of reimbursement parity compared to traditional visits (15.5%). Fewer than 9.0% of respondents experienced technological issues. On average, respondents agreed that telemedicine increases access to care for rural/long-distance patients, provides societal cost savings, and increases patient convenience. Responses were mixed about whether telemedicine leads to greater patient satisfaction. North Americans experienced the most challenges, but also thought telemedicine carried the most benefits, whereas Africans reported the fewest challenges and benefits. Age did not affect responses. Conclusion Spine surgeons are supportive of the benefits of telemedicine, and only a small minority experienced technical issues. The decreased ability to perform the physical examination was the top challenge and remains a major obstacle to virtual care for spine surgeons around the world, although interestingly, 61.4% of providers did not acknowledge this to be a major challenge. Significant groundwork in optimizing remote physical examination maneuvers and achieving legal and reimbursement clarity is necessary for widespread implementation.

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“…There are now several publications that describe a virtual neurologic examination [ 44 , 45 ]. There is also a growing number of publications addressing the possibility of virtual spine examination [ 46 , 47 , 48 ], although none of these virtual examinations have been studied for validity or reliability.…”

Section: Discussionmentioning

confidence: 99%

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

Haldeman¹,

Nordin²,

Tavares³

et al. 2021

JMIR Public Health Surveill

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Background The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

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The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

Cited by 39 publications

References 33 publications

Telemedicine visits generate accurate surgical plans across orthopaedic subspecialties

Telemedicine visits generate accurate surgical plans across orthopaedic subspecialties

Spine surgeon perceptions of the challenges and benefits of telemedicine: an international study

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

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