Defining clinical decision making in the provision of audio-visual outpatient care for acute upper limb trauma services: A review of practice

McMullen, Emily; Robson, M.; Valand, Poonam; Sayed, Leela; Steele, James

doi:10.1016/j.bjps.2020.08.104

Cited by 3 publications

(7 citation statements)

References 1 publication

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“…During this ‘Moderate’ COVID-19 risk phase, approximately half of the hand therapy appointments were conducted via telehealth, thus significantly decreasing foot traffic into the hospital, and thus reducing potential COVID-19 transmission. McMullen and colleagues 5 stress the importance of developing systems that identify and mitigate clinical risks, while optimizing patient outcomes. While the guidelines developed for telehealth service delivery may have enabled satisfactory service provision to participants in this study, there is a need to develop standardized decision-making processes that can be used by therapists within and beyond a single health service, thus ensuring patients are offered telehealth in an equitable and systematic manner.…”

Section: Discussionmentioning

confidence: 99%

“…Literature published since the start of the pandemic, specific to hand therapy telehealth services, has primarily focused on the therapist experience of providing telehealth. 4 , 5 , 6 , 7 Szekeres and Valdes’ 7 survey of 819 therapists early in the COVID-19 pandemic (May 2020), that recruited from hand therapy associations in the United States, Canada, Australia and Europe, showed that very few therapists (n=38, 5%) had telehealth experience prior to the pandemic. The majority of therapists (n=557, 68%) reported they would be extremely or somewhat likely to continue with telehealth sessions once the pandemic settles.…”

Section: Introductionmentioning

confidence: 99%

“… 7 However, in the United Kingdom, 92% of hand therapy units surveyed continued to hold concerns relating to the use of audio-visual care, either overall or for certain patients. 5 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring the patient experience of telehealth hand therapy services during the COVID-19 pandemic

Hirth¹,

Hahn²,

Jamwal³

2023

Journal of Hand Therapy

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exploring the patient experience of telehealth hand therapy services during the COVID-19 pandemic

Hirth¹,

Hahn²,

Jamwal³

2023

Journal of Hand Therapy

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“…5–7 For upper limb trauma teams, this resulted in the rapid upscaling of new, technology-enabled service delivery options. 4,8…”

Section: Introductionmentioning

confidence: 99%

“…However, subsets of patients were identified as requiring at least one in-person review in order to optimise clinical outcome. 8 Building on these observations, the decision was made to pilot a clinical decision-making tool to support staff to determine either remote or in-person care. The tool was developed and successfully implemented at pace in April 2020.…”

Section: Introductionmentioning

confidence: 99%

Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences

et al. 2020

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Introduction For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

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The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review

Maltby,

Underhill,

Woodbridge

2023

Hand Therapy

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Introduction In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. Methods This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Results Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted ‘hands-on’ treatment, resource and training concerns and limiting patient factors. Conclusions This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.

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Defining clinical decision making in the provision of audio-visual outpatient care for acute upper limb trauma services: A review of practice

Cited by 3 publications

References 1 publication

Exploring the patient experience of telehealth hand therapy services during the COVID-19 pandemic

Exploring the patient experience of telehealth hand therapy services during the COVID-19 pandemic

Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences

The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review

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