Telemedicine Management of Musculoskeletal Issues

 

Am Fam Physician. 2021 Feb 1;103(3):147-154.

Published online January 12, 2021.

Author disclosure: No relevant financial affiliations.

Telemedicine can provide patients with cost-effective, quality care. The coronavirus disease 2019 pandemic has highlighted the need for alternative methods of delivering health care. Family physicians can benefit from using a standardized approach to evaluate and diagnose musculoskeletal issues via telemedicine visits. Previsit planning establishes appropriate use of telemedicine and ensures that the patient and physician have functional telehealth equipment. Specific instructions to patients regarding ideal setting, camera angles, body positioning, and attire enhance virtual visits. Physicians can obtain a thorough history and perform a structured musculoskeletal examination via telemedicine. The use of common household items allows physicians to replicate in-person clinical examination maneuvers. Home care instructions and online rehabilitation resources are available for initial management. Patients should be scheduled for an in-person visit when the diagnosis or management plan is in question. Patients with a possible deformity or neurovascular compromise should be referred for urgent evaluation. Follow-up can be done virtually if the patient's condition is improving as expected. If the condition is worsening or not improving, the patient should have an in-office assessment, with consideration for referral to formal physical therapy or specialty services when appropriate.

Telemedicine has rapidly become a valuable tool during the coronavirus disease 2019 (COVID-19) pandemic.1 Given that musculoskeletal issues are a common reason for primary care visits,2,3 a standardized examination to evaluate these issues via telemedicine is useful. Video-assisted orthopedic consultation for selected patients is cost-effective and does not result in serious adverse events.4,5

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Video-assisted orthopedic consultation for selected patients is cost-effective.4

B

Economic evaluation based on randomized controlled trial comparing video-assisted remote consultation with standard care

Video-assisted orthopedic consultation for selected patients does not result in serious adverse events.5

B

Randomized controlled trial comparing video-assisted remote consultation at a regional medical center with standard consultation at an orthopedic outpatient clinic

The management of musculoskeletal conditions via telerehabilitation is effective in improving physical function, disability, and pain.24

B

Systematic review


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Video-assisted orthopedic consultation for selected patients is cost-effective.4

B

Economic evaluation based on randomized controlled trial comparing video-assisted remote consultation with standard care

Video-assisted orthopedic consultation for selected patients does not result in serious adverse events.5

B

Randomized controlled trial comparing video-assisted remote consultation at a regional medical center with standard consultation at an orthopedic outpatient clinic

The management of musculoskeletal conditions via telerehabilitation is effective in improving physical function, disability, and pain.24

B

Systematic review


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

This article discusses telemedicine methods and techniques, including visit preparation, history collection, virtual physical examination, and initial treatment options.

Virtual Visit Preparation

Before the visit, initial preparation includes confirming that the patient has functional audiovisual resources and providing instructions on ideal setting, camera angles, body positioning, and attire.6 The physician should review any previous imaging studies beforehand. Multiple telehealth platforms are compliant with the U.S. Health Insurance Portability and Accountability Act (HIPAA).7 A guide for preparing a medical practice for virtual visits was published previously in FPM.8

Virtual Musculoskeletal Evaluation

Patients should be asked about

The Authors

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NICOLE T. YEDLINSKY, MD, CAQSM, FAAFP, RMSK, is a faculty member with the University of Kansas Family Medicine Residency and Primary Care Sports Medicine Fellowship programs, and is an assistant professor in the Department of Family Medicine and Community Health at the University of Kansas Medical Center, Kansas City....

REBECCA L. PEEBLES, DO, CAQSM, FAAFP, is a faculty member at the Ehrling Bergquist Family Medicine Residency program, Offutt Air Force Base, Neb., and is an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md.

Address correspondence to Nicole T. Yedlinsky, MD, CAQSM, FAAFP, RMSK, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mailstop 4010, Kansas City, KS 66160 (email: nyedlinsky@kumc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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