Provider confidence in the telemedicine spine evaluation: results from a global study

Abstract

Purpose To utilize data from a global spine surgeon survey to elucidate (1) overall confidence in the telemedicine evaluation and (2) determinants of provider confidence. Methods Members of AO Spine International were sent a survey encompassing participant’s experience with, perception of, and comparison of telemedicine to in-person visits. The survey was designed through a Delphi approach, with four rounds of question review by the multi-disciplinary authors. Data were stratified by provider age, experience, telemedicine platform, trust in telemedicine, and specialty. Results Four hundred and eighty-five surgeons participated in the survey. The global effort included respondents from Africa (19.9%), Asia Pacific (19.7%), Europe (24.3%), North America (9.4%), and South America (26.6%). Providers felt that physical exam-based tasks (e.g., provocative testing, assessing neurologic deficits/myelopathy, etc.) were inferior to in-person exams, while communication-based aspects (e.g., history taking, imaging review, etc.) were equivalent. Participants who performed greater than 50 visits were more likely to believe telemedicine was at least equivalent to in-person visits in the ability to make an accurate diagnosis (OR 2.37, 95% C.I. 1.03–5.43). Compared to in-person encounters, video (versus phone only) visits were associated with increased confidence in the ability of telemedicine to formulate and communicate a treatment plan (OR 3.88, 95% C.I. 1.71–8.84). Conclusion Spine surgeons are confident in the ability of telemedicine to communicate with patients, but are concerned about its capacity to accurately make physical exam-based diagnoses. Future research should concentrate on standardizing the remote examination and the development of appropriate use criteria in order to increase provider confidence in telemedicine technology.

Surgeon, patient, and caregiver perspective of pediatric surgical telemedicine in the COVID-19 pandemic era

“…One of the most frequent deciding factors whether to choose a TME versus in-person visit in the future for both groups was the need for a physical exam. These findings are consistent with previous TME surveys, including surgical subspecialties, which have demonstrated lack of PE as a barrier to TME use [ 3 , 17 – 20 ]. Recently, several studies have published guidelines on physical examination during TMEs [ 21 , 22 ].…”

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

“…First, some components of the physical exam may be reliably conducted over telemedicine despite physicians' overall sentiment that it is inferior to the in-person exam. 25,27 Second, the clinical management decisions made by physicians, including surgical plans, strongly agree with decisions made based on in-person encounters. 28,29…”

“…Providers felt that physical exam-based tasks (eg provocative testing, assessing neurologic deficits and myelopathy) were inferior to in-person exams while communication-based components (eg history taking, imaging review) were equivalent. 27 Another study using an adult population examined the agreement between telehealth and in-person assessment of chronic lumbar spine conditions in terms of clinical management decisions. 28 After performing a virtual musculoskeletal exam, there was an 85.7% agreement in the selected management pathway, 76–93% agreement in referral to specific allied health professionals and 93% agreement that the clinical diagnosis was either the same or similar.…”

COVID-19 and its Impact on Back Pain

“…20 Over half of spine surgeons worldwide reported using telehealth to conduct a significant (>25%) number of patients visits. [21][22][23][24][25][26][27] This leads the potential to exacerbate healthcare disparities within underserved areas without internet access. [21][22][23][24][25][26][27] Should virtual health persist beyond the pandemic, infrastructure should be implemented into underserved areas across the developed and undeveloped world to increase access to experienced clinicians.…”

“…[21][22][23][24][25][26][27] This leads the potential to exacerbate healthcare disparities within underserved areas without internet access. [21][22][23][24][25][26][27] Should virtual health persist beyond the pandemic, infrastructure should be implemented into underserved areas across the developed and undeveloped world to increase access to experienced clinicians. This could potentially begin to address some of the disparities present in the current treatment of back pain in these areas.…”