Beraldo Rodrigo Alves, Conforto Gracitelli Mauro Emilio, Assunção Jorge Henrique, Brandão de Andrade E Silva Fernando, Ferreira Neto Arnaldo Amado, Kiyomoto Henry Dan, Checchia Caio Santos, Malavolta Eduardo Angeli
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil.
IJOT - Faculdade de Medicina de Jundiaí, Jundiaí, Brazil.
JSES Int. 2025 Jan 28;9(3):709-714. doi: 10.1016/j.jseint.2024.12.022. eCollection 2025 May.
Telemedicine has enhanced medical practice by increasing accessibility for patients in remote areas. In orthopedics, its use in shoulder surgery is recent but promising. However, there is still a need for studies that evaluate its effectiveness specifically in the setting of rotator cuff disorders. To evaluate reliability and reproducibility of treatment indications using telemedicine for patients with rotator cuff syndrome. Secondary objectives were assessment of physical examination accuracy and level of patient satisfaction.
This diagnostic accuracy study included patients diagnosed with rotator cuff syndrome, who were randomized into two groups as follows: telemedicine and in-person consultations. Both groups underwent two appointments conducted by different orthopedic surgeons. The agreement between treatment indications (nonsurgical, surgical, or conservative, with the possibility of switching to surgery) was assessed using the Kappa coefficient. Additionally, physical examination tests and patient satisfaction were also evaluated.
A total of 64 patients were evaluated, with 32 in each group. The reproducibility of teleconsultation for treatment indication was high in both groups, with Kappa values ranging from 0.82 to 0.93. For physical examination tests, reproducibility was high in the in-person group (Kappa between 0.63 and 1) but varied in the telemedicine group (Kappa between 0.11 and 1). The accuracy of the tests in the in-person group was high (sensitivity between 0.94 and 1; specificity between 0.66 and 1), whereas the telemedicine group showed greater variability (sensitivity between 0.60 and 1; specificity between 0.16 and 1). Patient satisfaction was high in both groups, with no significant differences ( > .676).
Teleconsultation is a reliable tool for indicating treatment in patients with rotator cuff syndrome, demonstrating high reproducibility and high patient satisfaction. However, the variability in the accuracy of tests that require strength assessment highlights the need for improvements in telemedicine protocols to ensure more robust and accurate evaluations.
远程医疗通过提高偏远地区患者的就医便利性，改善了医疗实践。在骨科领域，其在肩部手术中的应用尚属新兴，但前景广阔。然而，仍需要开展研究来专门评估其在肩袖疾病治疗中的有效性。本研究旨在评估远程医疗用于肩袖综合征患者治疗指征的可靠性和可重复性。次要目标是评估体格检查的准确性和患者满意度。
本诊断准确性研究纳入了被诊断为肩袖综合征的患者，将其随机分为两组：远程医疗组和面对面咨询组。两组均接受由不同骨科医生进行的两次会诊。使用Kappa系数评估治疗指征（非手术、手术或保守治疗，以及转为手术治疗的可能性）之间的一致性。此外，还评估了体格检查测试和患者满意度。
共评估了64例患者，每组32例。两组中远程会诊治疗指征的可重复性都很高，Kappa值在0.82至0.93之间。对于体格检查测试，面对面组的可重复性很高（Kappa值在0.63至1之间），但远程医疗组有所不同（Kappa值在0.11至1之间）。面对面组测试的准确性很高（敏感性在0.94至1之间；特异性在0.66至1之间），而远程医疗组的变异性更大（敏感性在0.60至1之间；特异性在0.16至1之间）。两组患者的满意度都很高，无显著差异（P>0.676）。
远程会诊是肩袖综合征患者治疗指征评估的可靠工具，具有高可重复性和高患者满意度。然而，需要力量评估的测试准确性存在变异性，这凸显了改进远程医疗方案以确保更可靠和准确评估的必要性。
