A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint

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

^# S. Scheidt and K. Welle are the corresponding authors.

Publication History

Article published online:
24 November 2020

• References/Literatur

• 1 Zhu N, Zhang D, Wang W. et al. A Novel Coronavirus from Patients with Pneumonia in China. N Engl J Med 2020; 382: 727-733 doi:10.1056/NEJMoa2001017
• 2 Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020; 382: 1679-1681
• 3 Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform 2010; 79: 736-771
• 4 Zajtchuk R, Gilbert GR. Telemedicine: a new dimension in the practice of medicine. Dis Mon 1999; 45: 197-262
• 5 Raven M, Butler C, Bywood P. Video-based telehealth in Australian primary health care: current use and future potential. Aust J Prim Health 2013; 19: 283-286
• 6 Donelan K, Barreto EA, Sossong S. et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Managed Care 2019; 25: 40-44
• 7 Tasneem S, Kim A, Bagheri A. et al. Telemedicine Video Visits for patients receiving palliative care: A qualitative study. Am J Hospice Palliat Care 2019; 36: 789-794
• 8 Andino JJ, Guduguntla V, Weizer A. et al. Examining the Value of Video Visits to Patients in an Outpatient Urology Clinic. Urology 2017; 110: 31-35
• 9 Brokmann JC, Rossaint R, Bergrath S. et al. Potenzial und Wirksamkeit eines telemedizinischen Rettungsassistenzsystems: Prospektive observationelle Studie zum Einsatz in der Notfallmedizin. Anaesthesist 2015; 64: 438-445
• 10 Braga AV. Die telemedizinische Konsultation. In: Pfannstiel M, Da-Cruz P, Mehlich H. Hrsg. Digitale Transformation von Dienstleistungen im Gesundheitswesen I. Wiesbaden: Springer Gabler; 2016: 93-108
• 11 Buckup K, Buckup J. Klinische Tests an Knochen, Gelenken und Muskeln. 6. Aufl.. Stuttgart: Thieme;; 2018
• 12 Weinstein RS, Krupinski EA, Doarn CR. Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices. Med Clin North Am 2018; 102: 533-544
• 13 Scheidt S, Rüwald J, Schildberg F. et al. A Systematic Review on the Value of Infrared Thermography in the Early Detection of Periprosthetic Joint Infections. Z Orthop Unfall 2020; 158: 397-405 doi:10.1055/a-0969-8675
• 14 Lamba P. Teleconferencing in Medical Education: A Useful Tool. Australas Med J 2011; 4: 442-447