School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada.
College of Arts and Science, University of Saskatchewan, Saskatoon, Canada.
J Telemed Telecare. 2024 Jun;30(5):842-850. doi: 10.1177/1357633X221098904. Epub 2022 May 12.
INTRODUCTION: Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models. METHODS: In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PT); 2) in-person PT (PT); and 3) in-person NP (NP). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa. RESULTS: Overall diagnostic categorization was compared for PT versus NP and NP/PT: percent agreement was 77.8% ( = 0.474, = 0.001) and 74.1% ( = 0.359, = 0.004), respectively. In terms of management recommendations, the PT and NP demonstrated strong agreement on "need for urgent surgical referral" (92.6%, = 0.649 ( < 0.00) and slight agreement for "refer to primary physician for pharmacology, lab or imaging" (81.5%, = 0.372 ( = 0.013). The PT and NP/PT demonstrated strong agreement on "need for urgent surgical referral" (96.3%, = 0.649, = 0.000) and "recommendation for PT follow up" (88.9%, = 0.664, = 0.000). DISCUSSION: The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.
简介:通过城市物理治疗师和农村初级保健护士从业者之间的视频会议链接进行虚拟护理,可能会克服获得护理的挑战,并为患有慢性下腰痛(CBD)的农村和偏远地区居民提供更好的护理。本研究的目的是评估这种新模式与两种传统模式的一致性。
方法:在这项横断面研究设计中,对 27 名 CBD 患者的每位患者进行评估:1)由一名在患者所在地的护士从业者(NP)组成的团队,通过视频会议加入一名物理治疗师(PT)(NP/PT);2)进行面对面的 PT(PT);3)进行面对面的 NP(NP)。使用百分一致率和κ值评估三组之间的诊断和管理一致性。
结果:对 PT 与 NP 和 NP/PT 的总体诊断分类进行了比较:百分一致率分别为 77.8%( = 0.474, = 0.001)和 74.1%( = 0.359, = 0.004)。在管理建议方面,PT 和 NP 在“需要紧急手术转诊”方面表现出高度一致(92.6%, = 0.649( < 0.00),而在“转介给初级医生进行药理学、实验室或影像学检查”方面表现出轻微一致(81.5%, = 0.372( = 0.013)。PT 和 NP/PT 在“需要紧急手术转诊”(96.3%, = 0.649, = 0.000)和“推荐进行 PT 随访”(88.9%, = 0.664, = 0.000)方面表现出高度一致。
讨论:使用视频会议对 CBD 进行团队诊断分类和管理建议与进行面对面的 PT 做出的决策相似。这种护理模式可能为在服务不足地区提供评估和初步管理 CBD 的 PT 提供了一种方法。