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

Abstract

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.

Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance

“…Eighteen articles/guidelines (59% of all the articles/guidelines), including most of the UK AHP professional bodies’ guidelines (n=7), stated the purpose of the guidance. They indicated that telehealth can be used for a variety of services including triage, 20–23 advice provision, 21 22 24 assessment, 18 19 22 25 intervention, 25–27 provision of piece of equipment, 18 remote monitoring, 23 24 26 27 service evaluation, 22 patient education, 21 24 27 consultations with other AHPs 22 26 and staff supervision. 24 27 …”

“…Eight articles/guidelines 19 21 25 26 29 32 38 mentioned that AHPs should make patients aware of the risks and limitations associated with telehealth. Risks related to a potential breach of privacy, confidentiality and security were acknowledged in five articles/guidelines, 19 25 26 29 32 limitations related to the assessments and treatments provided remotely in four 21 25 26 32 and other non-specified risks in two. 25 38 It was stated that patients should also be informed about the differences between telehealth and face-to-face consultations.…”

“…Eighteen articles/guidelines (66% of all included articles/guidelines), including most of the UK AHP professional body guidelines (n=6), 19 23 33 36–38 discussed the aspects concerning the privacy and security of telehealth consultations. Ten articles/guidelines 21 26 31 32 36 38–42 stated that AHPs must protect their patient’s privacy and ensure information security during data transmission and storage. Burns and Wall 31 specified that technology and data security should be guaranteed by all participating sites, even if they cross different health services, states and countries.…”

Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation—A Quality Assessment

“…The COVID-19 pandemic has led to demanding challenges in treating and diagnosing patients with spinal disorders such as lumbar disc herniation [ 22 , 23 , 25 ]. Meanwhile various guidelines for distance management of, e.g., spinal disorders have been published; however, the field of telemedicine still requires further research, validation and consequently improvement in order to provide the patients sufficiently [ 22 , 25 , 42 ]. As reported by Minghelli et al, the majority of physiotherapists interrupted their work in person and the overall accessibility and availability of physiotherapy has decreased during the ongoing pandemic [ 23 ].…”

Changes in the Use of Telehealth and Face-To-Face Chiropractic Care in the Department of Veterans Affairs Before and After the COVID-19 Pandemic

“…23 A recent international, interprofessional expert team developed patient and clinical guides to help triage cases and inform the use of telehealth in management of spinal disorders. 39 This represents an opportunity for chiropractors to facilitate continuity of care through the use of telephone and/or video methods. 21,40 In our study of chiropractic use of telehealth in the VHA, with the increased use of telehealth services, telephone visits were more frequently seen than video visits.…”