To explore, using semi-structured interviews, the perceptions of patients, clinicians and other stakeholders involved in telehealth regarding the perceived strengths and limitations of an initial remote evaluation for the diagnosis of MSKDs and the current environment of telehealth in the province of Quebec, Canada.
Semi-structured interviews were conducted in the province of Quebec with patients (n=11), health care providers (physiotherapists [n=10] and physicians [n=11]), telehealth software specialists (n=2) and regulatory organizations (n=4). Five interview guides, adapted to the different types of participants, were developed using the Consolidated Framework of Implementation Research and the framework of Mathieu-Fritz et al. for the study of telehealth interventions. The themes explored included participants’ previous experiences with telehealth, their perceived strengths and limitations of telehealth, particularly regarding the initial evaluation and diagnosis of new patients, and the current global environment of telehealth use. All semi-structured interviews were transcribed and inductive thematic analysis was performed. The framework of Mathieu-Fritz et al. was used as the template for analyses.
The main themes were: 1- Several participants felt that telehealth, including a remote evaluation, is a solution to improve access to care by reducing travel, wait times and time away from usual activities. 2- Patients and health care providers reported that a remote evaluation was more suitable for simple MSKD presentations. 3- Some clinicians expressed concerns about the potential increase in diagnostic errors and the feasibility of performing all usual components of a MSK physical examination. 4- Patients expressed doubts regarding their ability to perform some of the tasks or tests on themselves during the remote MSK physical examination and 5- More common issues related to the use of telerehabilitation were also highlighted by all such as the impact on the patient-clinician relationship, access to adequate hardware, general digital literacy, data management and issues with confidentiality.
The perceived challenges of remote evaluation, specifically those related to the remote physical examination and the increased risk of diagnostic errors, must be weighed against the opportunities for improving access to care. Providing specific training for health care providers and patients on the proper use of telehealth, including how to perform a remote physical examination and how to communicate and collaborate effectively in a virtual setting, is essential to facilitate successful remote evaluation.
The identified barriers, facilitators, and needs of patients and health care providers are important to acknowledge as they need to be taken into account to allow the development of effective strategies to implement remote evaluation to assess new patients with MSKDs.
Musculoskeletal disorders
Clinical evaluation
