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Article: Orthopedic Surgery and Telemedicine in Times of COVID-19 and Beyond: a Review.

Moisan, Philippe / Barimani, Bardia / Antoniou, John

Current reviews in musculoskeletal medicine

2021 Volume 14, Issue 2, Page(s) 155–159

Abstract: ... in the field of orthopedic surgery during the COVID-19 pandemic and beyond.: Recent findings: Orthopedic ... Telemedicine in orthopedic surgery has a potential to increase productivity, reduce costs, and increase ... to the pandemic. In this context and onward, telemedicine seems to be a reasonable option for the orthopedic ...

Abstract	Purpose of review: This review article presents the current knowledge on the use of telemedicine and summarizes the literature highlighting the advantages and limitations of this technology in the field of orthopedic surgery during the COVID-19 pandemic and beyond. Recent findings: Orthopedic surgery is the surgical specialty that has seen the highest proportion of its procedures cancelled due to the pandemic. In this context and onward, telemedicine seems to be a reasonable option for the orthopedic surgeon. Multiple studies have described its safety and a similar patient satisfaction compared to in-person consultations. It has a potential to increase productivity and decrease wait times by providing easier access to the clinician and by decreasing travel-associated limitations and costs. Authors have described the possibility to conduct a reliable virtual assessment of the patient range of motion. Some of the limitations to the use of this technology are technological literacy and access to virtual consultation platforms, the inability to conduct a complete physical examination, potential reduction in identification of intimate and child abuse victims, and limited knowledge about the legal implications of this technology. Telemedicine in orthopedic surgery has a potential to increase productivity, reduce costs, and increase the access to healthcare. Identified limitations include risk of misdiagnosis, required technologic literacy, unknown legal implications, and failure to identify victims of abuse. In order to use this technology judiciously, the clinician must take into consideration the patient's condition and his technological literacy and be aware of the advantages and disadvantages.
Language	English
Publishing date	2021-01-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2407827-X
ISSN	1935-9748 ; 1935-973X
ISSN (online)	1935-9748
ISSN	1935-973X
DOI	10.1007/s12178-021-09693-9
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Article ; Online: Examining Health Disparities in Orthopedic Care During COVID-19.

Pond, Kristina / Samuels, Kaitlyn / Meinhardt, Gerek / Jacobs, Cale

The American surgeon

2023 Volume 89, Issue 4, Page(s) 583–588

Abstract: ... between the time period prior to and during the pandemic.: Results: During the COVID-19 pandemic, there ... to COVID-19 (April 2018, 2019), and during the COVID-19 pandemic (2020) were retrospectively reviewed ... healthcare disparities, including access to healthcare in the outpatient orthopedic surgery clinic.: Methods ...

Abstract	Background: Demographics and socioeconomic status affect the delivery of medical care resulting in healthcare disparities. The purpose of this study was to investigate the impact of COVID-19 on existing healthcare disparities, including access to healthcare in the outpatient orthopedic surgery clinic. Methods: The medical records of 3006 patients treated at the University of Kentucky Orthopedic Surgery Department prior to COVID-19 (April 2018, 2019), and during the COVID-19 pandemic (2020) were retrospectively reviewed for demographic data, distance to clinic, and type of visit. We then compared the total number of patient visits, new patient visits, telehealth visits, and the patient's insurance provider (public or private) between the time period prior to and during the pandemic. Results: During the COVID-19 pandemic, there were significant declines in the number of patients seen, new patient presentations, and publicly insured patients. Thirty-three percent of visits were telemedicine visits in 2020 compared to 0% pre-COVID ( Discussion: While COVID-19 resulted in a significant decline in overall access to care, there were negative ramifications particularly on patients with new complaints and those of lower socioeconomic status. Future endeavors should be focused on correcting the obstacles to accessing care, exacerbated by the pandemic, that these vulnerable populations face.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Pandemics ; Retrospective Studies ; Outpatients ; Ambulatory Care Facilities
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231153551
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Article: COVID-19. An update for orthopedic surgeons.

Abdelnasser, Mohammad Kamal / Morsy, Mohamed / Osman, Ahmed E / AbdelKawi, Ayman F / Ibrahim, Mahmoud Fouad / Eisa, Amr / Fadle, Amr A / Hatem, Amr / Anter Abdelhameed, Mohammed / Hassan, Ahmed Abdelazim A / Shawky Abdelgawaad, Ahmed

SICOT-J

2020 Volume 6, Page(s) 24

Abstract: The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery ... of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries ... speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery ...

Abstract	The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
Keywords	covid19
Language	English
Publishing date	2020-07-01
Publishing country	France
Document type	Journal Article
ZDB-ID	2832091-8
ISSN	2426-8887
ISSN	2426-8887
DOI	10.1051/sicotj/2020022
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Article ; Online: COVID-19. An update for orthopedic surgeons

Abdelnasser Mohammad Kamal / Morsy Mohamed / Osman Ahmed E. / AbdelKawi Ayman F. / Ibrahim Mahmoud Fouad / Eisa Amr / Fadle Amr A. / Hatem Amr / Anter Abdelhameed Mohammed / Hassan Ahmed Abdelazim A. / Shawky Abdelgawaad Ahmed

SICOT-J, Vol 6, p

2020 Volume 24

Abstract	The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
Keywords	covid-19 ; orthopaedics ; Orthopedic surgery ; RD701-811 ; covid19
Subject code	306
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	EDP Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: COVID-19. An update for orthopedic surgeons

SICOT J

Abstract	The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #623515
Database	COVID19

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Article: COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons.

Chhabra, Harvinder Singh / Bagaraia, Vaibhav / Keny, Swapnil / Kalidindi, Kalyan Kumar Varma / Mallepally, Abhinandan / Dhillon, Mandeep Singh / Malhotra, Rajesh / Rajasekharan, Shanmuganathan

Indian journal of orthopaedics

2020 Volume 54, Issue 4, Page(s) 411–425

Abstract: ... of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge ... telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned ... surgeon who should seek the opportunity within the adversity and use this time wisely to achieve ...

Abstract	Background: A mysterious cluster outbreak of pneumonia in Wuhan, China in December 2019 was traced to Severe Acute Respiratory Syndrome Coronavirus 2 and declared a Pandemic by WHO on 11th March 2020. The pandemic has spread rapidly causing widespread devastation globally. Purpose: This review provides a brief understanding of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge as well as best practices for orthopaedic surgeons. These are likely to change as knowledge and evidence is gained. Results: Orthopaedic surgeons, like other front-line workers, carry the risk of getting infected during their practice, which as such is already substantially affected. Implementation of infection prevention and control as well as other safety measures for health care workers assumes great importance. All patients/visitors and staff visiting the hospital should be screened. Conservative treatment should be the first line of treatment except for those requiring urgent/emergent care. During lockdown all elective surgeries are to be withheld. All attempts should be made to reduce hospital visits and telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned authorities. All patients being admitted to the hospital in and around containment zones should be tested for COVID-19. There are special considerations for anaesthesia with preference for regional anaesthesia. A separate Operation room with specific workflow should be dedicated for COVID-19 positive cases. Conclusions: Despite the magnitude of challenge, the pandemic offers significant lessons for the orthopaedic surgeon who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai.
Keywords	covid19
Language	English
Publishing date	2020-05-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	603194-8
ISSN	0019-5413
ISSN	0019-5413
DOI	10.1007/s43465-020-00135-1
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Article ; Online: Adapting Orthopaedic Surgery Training Programs During the COVID-19 Pandemic and Future Directions.

Zhang, Andrew S / Myers, Mitchell / Kee, Clarence J / McClary, Kaylan N / Barton, R Shane / Massey, Patrick A

Arthroscopy, sports medicine, and rehabilitation

2020 Volume 2, Issue 5, Page(s) e683–e696

Abstract: The COVID-19 pandemic swept across the world, altering the structure and existence ... these unprecedented times to continue providing meaningful education to trainees and to continue providing high ... online didactic education, resident wellness, return to elective surgery, and factors affecting ...

Abstract	The COVID-19 pandemic swept across the world, altering the structure and existence of graduate medical education programs across all disciplines. Orthopaedic residency programs can adapt during these unprecedented times to continue providing meaningful education to trainees and to continue providing high-quality patient care, all while keeping both residents and patients safe from disease. The purpose of this review was to evaluate the literature and describe evidence-based changes that can be made in an orthopaedic residency program to ensure patient and resident safety while sustaining the principles of graduate medical education during the COVID-19 pandemic. We describe measures that can be enacted now or during future pandemics, including workforce and occupational modifications, personal protective equipment, telemedicine, online didactic education, resident wellness, return to elective surgery, and factors affecting medical students and fellows. After a review of these strategies, programs can make changes for sustainable improvements and adapt to be ready for second-wave events or future pandemics. Level of evidence: Level V.
Keywords	covid19
Language	English
Publishing date	2020-06-25
Publishing country	United States
Document type	Journal Article
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2020.06.008
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic.

Massey, Patrick A / McClary, Kaylan / Zhang, Andrew S / Savoie, Felix H / Barton, R Shane

The Journal of the American Academy of Orthopaedic Surgeons

2020 Volume 28, Issue 11, Page(s) 436–450

Abstract: ... surgery" and recommending social or physical distancing. We review the literature on several areas ... This literature review sought to provide evidence-based guidance to orthopaedic departments during an unprecedented time ... such as inpatient telemedicine and online file sharing applications can enable orthopaedic programs to still ...

Abstract	The novel coronavirus pandemic, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed an immense strain on healthcare systems across the entire world. Consequently, multiple federal and state governments have placed restrictions on hospitals such as limiting "elective surgery" and recommending social or physical distancing. We review the literature on several areas that have been affected including surgical selection, inpatient care, and physician well-being. These areas affecting inpatient paradigms include surgical priority, physical or social distancing, file sharing for online clinical communications, and physician wellness. During this crisis, it is important that orthopaedic departments place an emphasis on personnel safety and slowing the spread of the virus so that the department can still maintain vital functions. Physical distancing and emerging technologies such as inpatient telemedicine and online file sharing applications can enable orthopaedic programs to still function while attempting to protect medical staff and patients from the novel coronavirus spread. This literature review sought to provide evidence-based guidance to orthopaedic departments during an unprecedented time. Orthopaedic surgeons should follow the Centers for Disease Control and Prevention guidelines, wear personal protective equipment (PPE) when appropriate, have teams created using physical distancing, understand the department's policy on elective surgery, and engage in routines which enhance physician wellness.
MeSH term(s)	COVID-19 ; Communicable Disease Control/organization & administration ; Coronavirus Infections/epidemiology ; Elective Surgical Procedures/methods ; Elective Surgical Procedures/statistics & numerical data ; Female ; Humans ; Inpatients/statistics & numerical data ; Male ; Occupational Health ; Orthopedic Procedures/statistics & numerical data ; Orthopedic Procedures/trends ; Pandemics/prevention & control ; Patient Isolation/methods ; Patient Safety ; Patient Selection ; Personal Protective Equipment/statistics & numerical data ; Pneumonia, Viral ; Program Development ; Program Evaluation ; Safety Management/organization & administration ; United States
Keywords	covid19
Language	English
Publishing date	2020-05-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-20-00360
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Article: COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons

Chhabra, Harvinder Singh / Bagaraia, Vaibhav / Keny, Swapnil / Kalidindi, Kalyan Kumar Varma / Mallepally, Abhinandan / Dhillon, Mandeep Singh / Malhotra, Rajesh / Rajasekharan, Shanmuganathan

Indian J Orthop

Abstract: ... of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge ... telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned ... who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai. ...

Abstract	Background: A mysterious cluster outbreak of pneumonia in Wuhan, China in December 2019 was traced to Severe Acute Respiratory Syndrome Coronavirus 2 and declared a Pandemic by WHO on 11th March 2020. The pandemic has spread rapidly causing widespread devastation globally. Purpose: This review provides a brief understanding of pathophysiology, clinical features, diagnosis and management of COVID-19 and highlights the current knowledge as well as best practices for orthopaedic surgeons. These are likely to change as knowledge and evidence is gained. Results: Orthopaedic surgeons, like other front-line workers, carry the risk of getting infected during their practice, which as such is already substantially affected. Implementation of infection prevention and control as well as other safety measures for health care workers assumes great importance. All patients/visitors and staff visiting the hospital should be screened. Conservative treatment should be the first line of treatment except for those requiring urgent/emergent care. During lockdown all elective surgeries are to be withheld. All attempts should be made to reduce hospital visits and telemedicine is to be encouraged. Inpatient management of COVID-19 patients requires approval from concerned authorities. All patients being admitted to the hospital in and around containment zones should be tested for COVID-19. There are special considerations for anaesthesia with preference for regional anaesthesia. A separate Operation room with specific workflow should be dedicated for COVID-19 positive cases. Conclusions: Despite the magnitude of challenge, the pandemic offers significant lessons for the orthopaedic surgeon who should seek the opportunity within the adversity and use this time wisely to achieve his/her Ikigai.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #291444
Database	COVID19

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Article ; Online: How Satisfied Are Patients and Surgeons with Telemedicine in Orthopaedic Care During the COVID-19 Pandemic? A Systematic Review and Meta-analysis.

Chaudhry, Harman / Nadeem, Shaheer / Mundi, Raman

Clinical orthopaedics and related research

2020 Volume 479, Issue 1, Page(s) 47–56

Abstract: ... around the terms "telemedicine", "telehealth", and "virtual care" combined with "orthopaedic", "orthopaedic surgery ... visits? (3) What is the difference in time commitment between telemedicine and in-person visits ... the levels of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care ...

Abstract	Background: The coronavirus disease 2019 pandemic has resulted in a rapid pivot toward telemedicine owing to closure of in-person elective clinics and sustained efforts at physical distancing worldwide. Throughout this period, there has been revived enthusiasm for delivering and receiving orthopaedic care remotely. Unfortunately, rapidly published editorials and commentaries during the pandemic have not adequately conveyed findings of published randomized trials on this topic. Questions/purposes: In this systematic review and meta-analysis of randomized trials, we asked: (1) What are the levels of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care delivery? (2) Are there differences in patient-reported outcomes between telemedicine visits and in-person visits? (3) What is the difference in time commitment between telemedicine and in-person visits? Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review with the primary objective to determine patient and surgeon satisfaction with telemedicine, and secondary objectives to determine differences in patient-reported outcomes and time commitment. We used combinations of search keywords and medical subject headings around the terms "telemedicine", "telehealth", and "virtual care" combined with "orthopaedic", "orthopaedic surgery" and "randomized." We searched three medical databases (MEDLINE, Embase, and the Cochrane Library) in duplicate and performed manual searches to identify randomized controlled trials evaluating the outcomes of telemedicine and in-person orthopaedic assessments. Trials that studied an intervention that was considered to be telemedicine (that is, any form of remote or virtual care including, but not limited to, video, telephone, or internet-based care), had a control group that comprised in-person assessments performed by orthopaedic surgeons, and were reports of Level I original evidence were included in this study. Studies evaluating physiotherapy or rehabilitation interventions were excluded. Data was extracted by two reviewers and quantitative and qualitive summaries of results were generated. Methodological quality of included trials was assessed using the Cochrane Risk of Bias tool, which uniformly rated the trials at high risk of bias within the blinding categories (blinding of providers, patients, and outcome assessors). We screened 133 published articles; 12 articles (representing eight randomized controlled trials) met the inclusion criteria. There were 1008 patients randomized (511 to telemedicine groups and 497 to control groups). Subspecialties represented were hip and knee arthroplasty (two trials), upper extremity (two trials), pediatric trauma (one trial), adult trauma (one trial), and general orthopaedics (two trials). Results: There was no difference in the odds of satisfaction between patients receiving telemedicine care and those receiving in-person care (pooled odds ratio 0.89 [95% CI 0.40 to 1.99]; p = 0.79). There were also no differences in surgeon satisfaction (pooled OR 0.38 [95% CI 0.07 to 2.19]; p = 0.28) or among multiple patient-reported outcome measures that evaluated pain and function. Patients reported time savings, both when travel time was excluded (17 minutes shorter [95% CI 2 to 32]; p = 0.03) and when it was included (180 minutes shorter [95% CI 78 to 281]; p < 0.001). Conclusion: Evidence from heterogeneous randomized studies demonstrates that the use of telemedicine for orthopaedic assessments does not result in identifiable differences in patient or surgeon satisfaction compared with in-person assessments. Importantly, the source studies in this review did not adequately capture or report safety endpoints, such as complications or missed diagnoses. Future studies must be adequately powered to detect these differences to ensure patient safety is not compromised with the use of telemedicine. Although telemedicine may lead to a similar patient experience, surgeons should maintain a low threshold for follow-up with in-person assessments whenever possible in the absence of further safety data. Level of evidence: Level I, therapeutic study.
MeSH term(s)	COVID-19 ; Humans ; Job Satisfaction ; Orthopedic Procedures ; Orthopedics ; Patient Satisfaction ; Telemedicine
Keywords	covid19
Language	English
Publishing date	2020-07-22
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/CORR.0000000000001494
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