New research from Germany compares aftercare orthopedic telemedical consultations to in-person consultations. Their study, “The use of online video consultations in the aftercare of orthopedic patients: a prospective case-control study,” appeared in the September 12, 2021, edition of BMC Musculoskeletal Disorders.
eMedicine: An E-normous Success in Orthopedic Aftercare
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This paper is part of a planned three publication series which will report on a larger one-year-project about online video consultations. The remaining two papers will address some of the logistical anomalies of online communications and how that affects hospital management.
“Digitalization is gaining more and more impact in our daily life and thus also in our ‘business’ as orthopedic and trauma surgeons,” explained co-author David Back, M.D., to OTW. “The video consultations especially enable us to get in contact with our patients more easily also over larger distances. Additionally, online telemedical consultation services in particular had been recently promoted by laws and governmental initiatives in Germany.”
Dr. Back is a member of the Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin and the Dieter Scheffner Center for Medical Education and Educational Research, Charité – Universitätsmedizin Berlin.
Dr Back and his team enrolled 53 study participants, all soldiers in the German Federal Armed Forces. The research subjects completed an orthopedic telemedical consultation and a live consultation.
According to the study authors, the study participants (both doctors and patients) rated their orthopedic telemedical consultation experience as very satisfying (average rating on a 5-point Likert scale, with 1 indicating strong agreement: doctors rated the experience as 1.2; patients rated it 1.3).
The authors identified various technical and organizational challenges. Compared to live consultations, orthopedic telemedical consultations showed no significant differences in patient history or in inspection, palpation, or active range of motion results. Only for the functional or passive joint assessment did live consultations show significantly higher suitability (p < 0.05) than orthopedic telemedical consultations.
Importantly, physician recommendations for further treatment did not differ significantly between orthopedic telemedical consultations and live consultations.
Dr. Back commented to OTW, “There was a high acceptance of the offered service on patients’ and doctors’ side. Patients’ history taking and many clinical examination findings can be well achieved by a video consultation even in orthopedics, making a follow-up after operations a good indication for this service. Challenges still exist in functional joint assessments and the implementation process of such a service in a clinical structure. The orthopedic video consultation service was extended also on primary visits of new patients as well as on presentations of patients to orthopedic specialists of the hospital by general practitioners in the connected health region.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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