A mixed-methods survey to explore issues with virtual consultations for musculoskeletal care during the COVID-19 pandemic

Abstract

Objective To explore orthopaedic and musculoskeletal clinicians’ views and experiences of legal, safety, safeguarding and security issues regarding the use of virtual consultations (VC) during the COVID-19 pandemic. A secondary objective was to suggest ways to overcome these issues. Methods A mixed method cross-sectional survey was conducted, seeking the views and experiences of orthopaedic and musculoskeletal medically qualified and Allied Health Professionals in the United Kingdom. Descriptive statistical analysis was employed for quantitative data and a qualitative content analysis undertaken for qualitative data. Findings were presented in accordance with the four key issues. Results Two hundred and ninety professionals (206 physiotherapists, 78 medically qualified professionals, 6 ‘other’ therapists) participated in the survey. Of the 290 participants, 260 (90%) were not using VC prior to the COVID-19 pandemic, 248 respondents (86%) were unsure whether their professional indemnity insurance covered VC, 136 (47%) had considered how they would handle an issue of safeguarding whilst the remainder had not, 126 (43%) had considered what they would do if, during a virtual consultation, a patient suffered an injury (e.g. bang on their head) or a fall (e.g. mechanical or a medical event like syncope) and 158 (54%) reported they felt the current technological solutions are secure in terms of patient data. Qualitative data provided additional context to support the quantitative findings such as validity of indemnification, accuracy of diagnosis and consent using VC, safeguarding issues; and security and sharing of data. Potential changes to practice have been proposed to address these issues. Conclusions VC have been rapidly deployed since the onset of the COVID-19 pandemic often without clear guidance or consensus on many important issues. This study identified legal, safeguarding, safety and security issues. There is an urgent need to address these and develop local and national guidance and frameworks to facilitate ongoing safe virtual orthopaedic practice beyond the COVID-19 pandemic.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

“…Gilbert et al. 33 observed that teleconsultations had been rapidly deployed since the onset of the COVID-19 pandemic, often without clear guidance or consensus on many important issues. They identified legal and security issues in telemedicine implementation.…”

Resilience Against COVID-19: How Italy Faced the Pandemic in Pediatric Orthopedics and Traumatology

“…The advent of models such as virtual clinics is completely re-designing the concept of care, offering a viable, efficient approach to treat a variety of pediatric musculoskeletal disorders, but this needs further studies, especially regarding legal, safeguarding, safety and security issues. [ 18 , 19 , 20 , 21 ]. Another and more worrying explanation could be that, while the overall volumes of trauma patients decreased, the injury pattern changed, as reported in recent studies concerning adult trauma [ 13 , 14 ], thus requiring hospitalization more frequently.…”

Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary

“…VC may lead to safeguarding issues through not being able to know, or control who was present at a consultation and it is important to ensure safeguarding policies at institutions consider issues arising from the use of VC. 30 Thorough evaluation of the effectiveness and safety of virtual management of patients is required to guide ongoing implementation moving forwards. Our work on rapid implementation found that, of the patients who underwent a video call, 44% of these would opt for a video for their next apppointment.…”