Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
School of Healthcare, University of Leeds, Leeds, UK.
Bone Joint J. 2019 Aug;101-B(8):951-959. doi: 10.1302/0301-620X.101B8.BJJ-2018-1566.R1.
This study aimed to develop a virtual clinic for the purpose of reducing face-to-face orthopaedic consultations.
Anonymized experts (hip and knee arthroplasty patients, surgeons, physiotherapists, radiologists, and arthroplasty practitioners) gave feedback via a Delphi Consensus Technique. This consisted of an iterative sequence of online surveys, during which virtual documents, made up of a patient-reported questionnaire, standardized radiology report, and decision-guiding algorithm, were modified until consensus was achieved. We tested the patient-reported questionnaire on seven patients in orthopaedic clinics using a 'think-aloud' process to capture difficulties with its completion.
A patient-reported 13-item questionnaire was developed covering pain, mobility, and activity. The radiology report included up to ten items (e.g. progressive periprosthetic bone loss) depending on the type of arthroplasty. The algorithm concludes in one of three outcomes: review at surgeon's discretion (three to 12 months); see at next available clinic; or long-term follow-up/discharge.
The virtual clinic approach with attendant documents achieved consensus by orthopaedic experts, radiologists, and patients. The robust development and testing of this standardized virtual clinic provided a sound platform for organizations in the United Kingdom to adopt a virtual clinic approach for follow-up of hip and knee arthroplasty patients. Cite this article: 2019;101-B:951-959.
本研究旨在开发一个虚拟诊所，以减少面对面的矫形咨询。
匿名专家（髋关节和膝关节置换患者、外科医生、物理治疗师、放射科医生和关节置换医生）通过德尔菲共识技术提供反馈。这包括一个迭代的在线调查序列，在此期间，虚拟文件（由患者报告的问卷、标准化的放射学报告和决策指导算法组成）被修改，直到达成共识。我们在骨科诊所对七名患者进行了患者报告的问卷测试，使用“思考 aloud”过程来捕捉其完成的困难。
开发了一个包含疼痛、活动度和活动能力的患者报告的 13 项问卷。放射学报告包括多达十个项目（例如，进行性假体周围骨丢失），具体取决于关节置换的类型。该算法得出三个结果之一：由外科医生自行决定进行复查（三至 12 个月）；在下次就诊时进行检查；或长期随访/出院。
附有相关文件的虚拟诊所方法得到了矫形专家、放射科医生和患者的一致认可。该标准化虚拟诊所的稳健开发和测试为英国的各个机构提供了一个可靠的平台，使其能够采用虚拟诊所方法来对髋关节和膝关节置换患者进行随访。
