Background: Telemedicine utilization increased exponentially due to the coronavirus disease 2019 (COVID-19) pandemic. As a result, most clinicians now have experience with telemedicine. Questions/Purposes: We studied factors independently associated with a clinician desiring to continue telemedicine services after the COVID-19 pandemic. Secondarily, we sought factors independently associated with clinician satisfaction with the quality of care provided through telemedicine and factors associated with telemedicine platform preference by clinicians. Methods: A large multispecialty medical group of physicians were invited to complete a survey, including demographics, telemedicine experience, satisfaction with various elements of telemedicine encounters, desired features in a telemedicine platform, personality traits, and preferences. A total of 220 complete responses were analyzed. Results: A desire to continue offering telemedicine visits after the COVID-19 pandemic was independently associated with a higher satisfaction with the quality of telemedicine care, endorsement of the ease of performing a physical examination with telemedicine, belief that adaptability is an important element of being a clinician, and less preference for in-person work meetings over virtual meetings. Higher satisfaction with the quality of telemedicine care was associated with belief that adaptability is an important element of being a clinician, clinicians who identify as being more perceiving (value flexibility) than judging (value organization), providers from relatively urban counties, and those with less preference for in-person work meetings over virtual meetings. Clinicians ranked ease of use for patients and physicians as the most important features of telemedicine platforms. Conclusions: The observed association of clinician personality and interpersonal preferences with the appeal, satisfaction, and perceived effectiveness of telemedicine merit additional study. Early implementation of telemedicine might be easiest with clinicians that take pride in their adaptability and value a technology-based workstyle.

Background: Prior studies have suggested that misconceptions (i.e., unhelpful thoughts or cognitive errors resulting from cognitive bias) and distress (symptoms of anxiety or depression) are key factors associated with variation in health, as quantified with use of patient-reported outcome measures. The primary purpose of the present study was to identify mental-health phenotypes (i.e., combinations of various types of misconceptions and distress) that might help direct care and to test for differences in magnitude of activity tolerance, pain intensity, and self-efficacy in response to pain between phenotypes. We also studied demographic factors and diagnostic categories associated with mental-health phenotypes.Methods: In a cross-sectional study, 137 patients seeking upper-extremity musculoskeletal specialty care completed a survey including demographics, mental-health questionnaires, and measures of upper-extremity-specific activity tolerance, pain intensity, and pain self-efficacy. We used cluster analysis to identify groups of patients with similar phenotypes. We used analysis of variance testing to assess differences in activity tolerance, pain intensity, and pain self-efficacy among phenotypes. Results:The cluster analysis yielded 4 unique mental-health phenotypes, which fit the theoretical conceptualizations of "low misconception and low distress," "notable misconception," "notable depression and notable misconception," and "notable anxiety, depression, and misconception." Patients with low bias and low distress had significantly greater activity tolerance and greater pain self-efficacy than the other phenotypes, as well as a significantly lower pain intensity than phenotypes with notable distress.Conclusions: Cluster analysis of mental-health questionnaire data can identify mental-health phenotypes that are associated with greater activity tolerance and pain intensity. This approach might help clinicians to strategize and prioritize approaches that correct unhelpful thoughts and ameliorate symptoms of distress among patients seeking musculoskeletal specialty care. Such strategies have the potential to achieve more comprehensive, whole-person care, more selective operative treatment, and improved outcomes.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Extensive research regarding musculoskeletal illness has established that variations in the intensity of pain and magnitude of activity intolerance cannot be explained through a purely biomedical paradigm. In other words, there is limited correspondence between objective pathology and the state of being unwell (i.e., illness). Prior studies indicate that this variation in illness may be the result of psychological factors, such as common misconceptions about symptoms (i.e., cognitive biases) and the symptoms of anxiety or depression (i.e., distress) 1-7 .These cognitive biases are common and arise from the normal functioning of the human mind. The Nobel Prize-winning research of Kahneman ...

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BackgroundCarpal tunnel release can stop the progression of idiopathic median neuropathy at the wrist (carpal tunnel syndrome). Intermittent symptoms tend to resolve after surgery, but loss of sensibility can be permanent. Both pathophysiology (severe neuropathy) and mental health (symptoms of despair or worry) contribute to problematic recovery after carpal tunnel release, but their relative associations are unclear.Question/purposeIs problematic initial recovery after carpal tunnel release associated with psychologic distress rather than with disease severity?MethodsWe retrospectively studied 156 patients who underwent in-office carpal tunnel release between November 2017 and February 2020, and we recorded their symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD]) and depression (Patient Health Questionnaire), signs of severe median neuropathy (loss of sensibility, thenar muscle atrophy, and palmar abduction weakness), and problematic recovery. The initial recovery (first 2 weeks) was categorized as problematic if the patient was upset about persistent numbness, experienced unsettling postoperative pain, developed hand stiffness, or experienced wound issues—all of which are routinely recorded in the medical record by the treating surgeon along with signs of severe median neuropathy. Twenty-four percent (38 of 156) of patients had a problematic initial recovery characterized by distress regarding persistent numbness (16% [25 of 156]), unsettling pain (8% [12 of 156]), hand stiffness (5% [8 of 156]), or wound issues (1% [2 of 156]); 6% (9 of 156) of patients had more than one issue. Associations between problematic initial recovery and age, gender, symptoms of anxiety and depression, disease severity, specific exam findings, and insurance were evaluated using t-tests, Mann-Whitney tests, and chi-square tests, with the plan to perform logistic regression if at least two variables had an association with p < 0.10.ResultsThe only factor associated with problematic initial recovery was greater symptoms of anxiety (median GAD score 1.5 [interquartile range 0 to 7.8] for problematic initial recovery compared with a median score of 0 [IQR 0 to 2] for nonproblematic recovery; p = 0.04), so we did not perform a logistic regression. Physical examination findings consistent with severe median neuropathy were not associated with problematic initial recovery.ConclusionThe finding that problematic initial recovery after carpal tunnel release was related to symptoms of anxiety and not to the severity of median neuropathy highlights the need to study the ability of efforts to ameliorate anxiety symptoms before carpal tunnel release as an effective intervention to reduce unplanned visits and additional tests, therapy, and repeat surgery, while improving patient-reported outcomes and experience.Level of EvidenceLevel III, therapeutic study.

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