Telemedicine in an Outpatient Shoulder Clinic

Background: Telemedicine, the provision of medical services and/or consultations by use of internet-based or cellular communication, has the potential to facilitate communication between patients and physicians and save valuable resources to the medical system. The purpose of this study was to determine the reliability and accuracy of diagnosis and management of orthopedic patients via telemedicine.

Methods: Consecutive patients attending an outpatient shoulder clinic within a large metropolitan medical center were recruited for this study. Patients underwent a standard (face-to-face) assessment by an orthopaedic surgeon, as well as assessment by another orthopaedic surgeon through a video call from the patient’s own cellular device. The video call examination was performed without the assistance of local technology or medical personnel, to mimic the patient’s home environment. Each assessment included a history, physical examination and review of pertinent diagnostic studies. At the conclusion of each assessment the physician established the diagnosis as well as recommendations for additional diagnostic studies and treatment. Agreement between physicians regarding diagnosis, additional diagnostic studies and treatment was examined. Differences in duration and satisfaction between the face-to-face and video assessments were also assessed.

Results: Fifty (18 females) patients (age: 44.6 ± 22.0 years, height: 172.3 ± 10.4 cm, weight: 75.0 ± 13.7 kg) were included in the study. The standard examination was completed on all 50 participants, while the video examination was terminated prematurely in 4 participants due to technical or language barriers. Percent agreement and kappa coefficient (95% CI) for the agreement regarding the diagnosis, need for additional diagnostic studies and treatment were 80% and 0.75 (0.62 – 0.89), 66.7% and 0.49 (0.28 – 0.70), and 75.6% and 0.51 (0.27 – 0.76). The mean duration of telemedicine examination was significantly longer (12.4 versus 9.0 minutes, P<0.01), and patient as well as physician satisfaction were lower. (24.9 vs. 22.7 points and 25.0 versus 21.1 points [0 – 25 scale])

Discussion: Substantial agreement regarding diagnosis, and moderate agreement regarding the need for additional diagnostic studies and treatment were found. Assessment by video call may be a clinically acceptable mode of managing patients with shoulder disorders.