JMIR Publications

ABSTRACT

Background:

Access to care for patients with musculoskeletal disorders (MSKDs) remains a significant challenge. Telehealth has emerged as a promising solution to improve access to care. However, conducting initial evaluations of MSKDs remotely raises concerns about patient safety and clinical efficacy due to the necessary adaptations of a clinical examination and the challenges of obtaining an accurate and reliable diagnosis without any physical contact with patients.

Objective:

To explore the use of telehealth for the initial evaluation of MSKDs in the province of Québec, Canada. Through semi-structured interviews with selected patients, health care providers and other key stakeholders involved in telehealth, this study aims to provide a comprehensive and detailed understanding of its application, benefits and challenges.

Methods:

Semi-structured interviews were conducted in the province of Quebec with patients, clinicians, telehealth software specialists, and professional bodies representatives. Five tailored interview guides were developed using the Consolidated Framework of Implementation Research and the Framework of Mathieu-Fritz for the study of telehealth interventions. The themes explored included participants’ prior experiences with telehealth, 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 interviews were transcribed verbatim and a reflexive thematic analysis was performed using the Mathieu-Fritz Framework.

Results:

Thirty eight participants, including patients (n=11), health care providers (family physicians and musculoskeletal medical specialists, n=11; physiotherapy professionals, n=10), telehealth software specialists (n=2), and representatives from professional bodies (n=4), shared their perspectives on telehealth for the initial evaluation of musculoskeletal disorders (MSKDs). Five key themes emerged: 1- Several participants viewed telehealth, including remote evaluations, as a solution to improve access to care; 2- Patients and health care providers reported that a remote evaluation was more appropriate for simpler MSKD presentations; 3- Some health care providers expressed concerns about the potential for increase in diagnostic errors and the challenges of performing all usual components of a standard MSKD physical examination remotely. 4- Patients expressed doubts about their ability to effectively perform certain tasks or tests on themselves during a remote physical examination and 5- Broader challenges were also highlighted by all participants such as the impact on the patient-clinician relationship, access to appropriate hardware, digital literacy and confidentiality concerns.

Conclusions:

Telehealth is seen as a valuable solution to improve access to care for patients with MSKDs, especially for simpler cases or urgent needs. However remote physical examination poses challenges associated with concerns about diagnostic accuracy and limited remote physical examination procedure and component. Effective implementation will likely require more evidence-based guidelines, provider training on remote techniques and strategies to maintain patient-provider relationships. Addressing access to technology, digital literacy, and privacy concerns is also essential to ensure equitable adoption and optimize telehealth in MSK care.