Scoping Review of Telehealth for Musculoskeletal Disorders: Applications for the COVID-19 Pandemic.

OBJECTIVE: The purpose of this scoping review was to identify information about telehealth and rehabilitation for the evaluation and management of musculoskeletal disorders, patient satisfaction, cost, and access as may be applicable during the COVID-19 pandemic. METHODS: We searched MEDLINE for studies published between January 1, 2000, and June 1, 2019. Search terms consisted of MEDLINE medical subject headings and other words relevant to this review, including "telerehabilitation," "musculoskeletal," "telemedicine," "therapy," "chiropractic," "ergonomics," and "exercise." This review targeted studies of people aged 18 years and older with musculoskeletal concerns. Articles on diagnostic tests, effectiveness of treatment, patient satisfaction, access to care, and cost were included. RESULTS: Eleven studies were included in this review. Interrater reliability and agreement were moderate to high for several assessment procedures for the lower limb, elbow, and low back. Two clinical trials demonstrated that provider and patient simultaneous telehealth were equally as effective as in-office care. Patient and provider satisfaction with telehealth were reported to be equal to or higher than for conventional rehabilitation. We found no studies reporting cost or access. CONCLUSION: In the COVID-19 pandemic environment, telehealth is feasible for health care providers to provide rehabilitation services for their patients with various musculoskeletal conditions. Current evidence suggests that for some musculoskeletal disorders, telehealth evaluation may be reliable, treatment may be effective, and patient satisfaction may be good or better than for in-office care. Results from this study may help physiatry, physical therapy, and chiropractic health care providers in their decisions to implement telehealth during and after the COVID-19 pandemic.

The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities.

PURPOSE: The purpose of this study was to develop recommendations for prevention interventions for spinal disorders that could be delivered globally, but especially in underserved areas and in low- and middle-income countries. METHODS: We extracted risk factors, associations, and comorbidities of common spinal disorders (e.g., back and neck pain, spinal trauma, infection, developmental disorders) from a scoping review of meta-analyses and systematic reviews of clinical trials, cohort studies, case control studies, and cross-sectional studies. Categories were informed by the Global Spine Care Initiative (GSCI) classification system using the biopsychosocial model. Risk factors were clustered and mapped visually. Potential prevention interventions for individuals and communities were identified. RESULTS: Forty-one risk factors, 51 associations, and 39 comorbidities were extracted; some were associated with more than one disorder. Interventions were at primary, secondary, tertiary, and quaternary prevention levels. Public health-related actions included screening for osteopenia, avoiding exposure to certain substances associated with spinal disorders, insuring adequate dietary intake for vitamins and minerals, smoking cessation, weight management, injury prevention, adequate physical activity, and avoiding harmful clinical practices (e.g., over-medicalization). CONCLUSION: Prevention principles and health promotion strategies were identified that were incorporated in the GSCI care pathway. Interventions should encourage healthy behaviors of individuals and promote public health interventions that are most likely to optimize physical and psychosocial health targeting the unique characteristics of each community. Prevention interventions that are implemented in medically underserved areas should be based upon best evidence, resource availability, and selected through group decision-making processes by individuals and the community. These slides can be retrieved under Electronic Supplementary Material.