Farid Alexander R, Hresko M Timothy, Ghessese Semhal, Linden Gabriel S, Wong Stephanie, Hedequist Daniel, Birch Craig, Cook Danielle, Flowers Kelsey Mikayla, Hogue Grant D
Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Bone Joint Surg Am. 2024 Dec 4;106(23):2249-2255. doi: 10.2106/JBJS.23.01146. Epub 2024 Oct 2.
Telehealth visits (THVs) have made it essential to adopt innovative ways to evaluate patients virtually. This study validates a novel THV approach that uses educational videos and an instructional datasheet, enabling parents to use smartphones to measure their child's scoliosis at home or in telehealth settings.
We identified a prospective cohort of patients with adolescent idiopathic scoliosis (AIS) scheduled for follow-up care from March to July 2021. The angle of trunk rotation (ATR) was first measured at home by patients' guardians using instructional video guidance and a smartphone application with internal accelerometer software. The second measurement was made during a THV examination performed by caregivers with supervision by trained associates via a telehealth appointment. Lastly, the clinician measured the child's ATR during an in-person clinic visit. Intraclass correlation coefficients (ICCs) and interrater reliability were compared between in-person clinic measurements and (1) at-home and (2) THV measurements. Shoulder, lower back, and pelvic asymmetry were observed and quantified at home and virtually, and then were compared with in-person clinic evaluations using kappa values. Surveys were used to evaluate the experience of the patient/caregiver with the at-home and telehealth assessment tools.
Seventy-three patients were included (mean age, 14.1 years; 25% male). There was excellent agreement in the ATR measurements between THVs and in-person visits (ICC = 0.88; 95% confidence interval [CI] = 0.83 to 0.92). ATR agreement between at-home and in-person visits was also excellent, but slightly diminished (ICC = 0.76; 95% CI = 0.64 to 0.83). Agreement between THV and in-person measurements was significantly higher compared with that between at-home and in-person measurements (p = 0.04). There was poor agreement in lower back asymmetry between THV and in-person assessments (kappa = 0.37; 95% CI = 0.14 to 0.60); however, there was no significant agreement between at-home and in-person assessments (kappa = 0.06; 95% CI = -0.17 to 0.29). Patient/caregiver satisfaction surveys (n = 70) reported a median score of 4 ("good") for comfort with use of the technology, and a score of 3 ("neutral") for equivalence of THV and in-person evaluation.
There was a high level of agreement between telehealth and in-person spine measurements, suggesting that THVs may be reliably used to evaluate AIS, thus improving access to specialized care.
Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
远程医疗问诊（THV）使得采用创新方法对患者进行虚拟评估变得至关重要。本研究验证了一种新型的远程医疗问诊方法，该方法使用教育视频和指导数据表，使家长能够使用智能手机在家中或远程医疗环境中测量孩子的脊柱侧弯情况。
我们确定了一组2021年3月至7月计划进行随访护理的青少年特发性脊柱侧弯（AIS）患者前瞻性队列。首先由患者监护人在家中使用教学视频指导和带有内置加速度计软件的智能手机应用程序测量躯干旋转角度（ATR）。第二次测量是在护理人员通过远程医疗预约在经过培训的同事监督下进行的远程医疗问诊检查期间进行的。最后，临床医生在面对面的门诊就诊期间测量孩子的ATR。比较了面对面门诊测量与（1）在家测量和（2）远程医疗问诊测量之间的组内相关系数（ICC）和评分者间信度。在家中和虚拟环境中观察并量化肩部、下背部和骨盆不对称情况，然后使用kappa值与面对面门诊评估进行比较。通过调查评估患者/护理人员使用家庭和远程医疗评估工具的体验。
纳入73例患者（平均年龄14.1岁；25%为男性）。远程医疗问诊和面对面就诊之间的ATR测量结果具有高度一致性（ICC = 0.88；95%置信区间[CI] = 0.83至0.92）。在家测量和面对面就诊之间的ATR一致性也很高，但略有下降（ICC = 0.76；95% CI = 0.64至0.83）。与在家测量和面对面测量之间相比，远程医疗问诊和面对面测量之间的一致性显著更高（p = 0.04）。远程医疗问诊和面对面评估之间下背部不对称的一致性较差（kappa = 0.37；95% CI = 0.14至0.60）；然而，在家测量和面对面评估之间没有显著一致性（kappa = 0.06；95% CI = -0.17至0.29）。患者/护理人员满意度调查（n = 70）报告，使用该技术的舒适度中位数评分为4（“良好”），远程医疗问诊与面对面评估等效性的评分为3（“中性”）。
远程医疗和面对面脊柱测量之间具有高度一致性，表明远程医疗问诊可可靠地用于评估青少年特发性脊柱侧弯，从而改善获得专科护理的机会。
诊断性II级。有关证据水平的完整描述，请参阅作者须知。
