Abstract
Background In times of a pandemic threat, such as COVID-19, and the need
for reduced direct doctor-patient contact, internet-based telemedicine has
attracted more and more attention as a surrogate service. Suspending the
diagnosis and treatment of non-virus related diseases for longer periods of time
is not a viable option since this would only exacerbate problems on the patient
and national level. The need for alternative treatment modalities increased
rather quickly. So far, telemedical applications have mainly focused on
teleradiological diagnosis, follow-up and monitoring of psychiatric and internal
diseases, as well as geriatric patient care. As far as these authors are aware,
orthopaedic physical examination of the knee joint, including trauma work-up,
has not been the subject of any studies to date. This feasibility study explores
how video consultation can be designed and implemented in the context of history
taking and physical examination in knee joint complaints.
Material and Method 21 patient actors (PA) with simulated complaints of
the knee joint were examined individually for each diagnosis, first via video
consultation and then directly by a specialist (SP). One PA group has a medical
background, the other was made up of laypersons. The time was measured for both
types of consultation. The physician documented the detected symptoms, the
quality of implementation of the self-examination steps, and the derived
diagnosis on an assessment form. After completion of both consultation sessions,
the PAs were handed a questionnaire on the respective examination modality.
Results With the video consultation the examination lasted 8.63 (± 2.5)
minutes on average and with the regular consultation in person 5.63 (± 1.7)
minutes (p < 0.001). For the group with medical background the examination
lasted 7.67 (± 1.4) minutes on average, while for the lay group the video
consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video
consultation was prolonged (p = 0.032; r = 0.47). The mean value for
self-examination of leg axis, gait pattern and degrees of freedom was 9.32
(± 0.4) of 10 points. The following functional tests resulted in lower mean
values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4
(± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the
feasibility of self-examination was 2.43 (± 0.98) out of 5 points.
Conclusion The video consultation for musculoskeletal complaints of the
knee joint allows exploratory remote examination and helps to minimise the
number of patients in hospitals and practices. It takes longer for the physician
to perform and does not permit functional testing for ligament injuries of the
knee joint. In its present form, telemedical examination is not able to fully
replace personal consultation.
Key words
knee - COVID-19 - examination - telemedicine - video consultation
