JSES international · 2025
Reliability and reproducibility of teleconsultation for evaluation and treatment indication of rotator cuff syndrome: a cross-sectional outcomes-based diagnostic study.
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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
Аннотация
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 (P > .676).
CONCLUSION: 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.
METHODS: 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.
RESULTS: 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 (P > .676).
CONCLUSION: 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.