Review Article (Meta-Analysis)
Are Nonpharmacologic Interventions Delivered Through Synchronous Telehealth as Effective and Safe as In-Person Interventions for the Management of Patients With Nonacute Musculoskeletal Conditions? A Systematic Rapid Review

https://doi.org/10.1016/j.apmr.2021.09.007Get rights and content

Abstract

Objective

To determine whether nonpharmacologic interventions delivered through synchronous telehealth are as effective and safe compared with in-person interventions for the management of patients with musculoskeletal conditions in improving pain, functioning, self-reported recovery, psychological outcomes, or health-related quality of life using rapid review methods.

Data Sources

We searched MEDLINE, CINAHL, Embase, and Cochrane Central Register of Controlled Trials from 2010 to August 2020 for randomized controlled trials (RCTs) published in English or French; we updated our search in January 2021.

Study Selection

One reviewer screened citations in 2 phases (phase 1: title/abstract; phase 2: full-text) selecting RCTs comparing synchronous telehealth with in-person care for the management of musculoskeletal conditions. A random 10% sample was screened by 2 independent reviewers with minimum 95% agreement prior to full screening. One reviewer critically appraised and one reviewer validated appraisal for eligible RCTs.

Data Extraction

One author extracted participant characteristics, setting, sample size, interventions, comparisons, follow-up period, and outcome data. A second author validated data extraction.

Data Synthesis

We summarized the findings narratively. Low- to moderate-quality evidence suggests that synchronous telehealth (ie, videoconference or telephone calls) alone or in combination with in-person care leads to similar outcomes as in-person care alone for nonspecific low back pain, generalized osteoarthritis, hip or knee osteoarthritis, and nonacute headaches in adults.

Conclusions

Synchronous telehealth may be an option for the management of nonacute musculoskeletal conditions in adults. However, our results may not be generalizable to rural or low socioeconomic populations. Future research should investigate the outcomes associated the use of new technologies, such as videoconference.

Section snippets

Protocol and registration

Our systematic rapid review followed the methods recommended by Tricco et al for health policy and systems research.16 It was commissioned by the College of Chiropractors of British Columbia (CCBC) to inform a telehealth policy in response to the first lockdown of the COVID-19 pandemic. The CCBC was consulted during the development of the study objective to ensure that our systematic review informed their policy needs. However, the CCBC was not involved in the design, conduct, analysis of the

Study selection

We identified 5683 citations and screened 3943 titles and abstracts (fig 1). Our update identified 116 additional citations and we screened 110 titles and abstracts after duplicate removal. Inter-rater agreement for title and abstract screening was 98.2%. We reviewed 110 full-text articles and 10 were eligible and critically appraised. Our search update yielded 1 relevant full-text article that was critically appraised.35 Three articles were published from 1 RCT36, 37, 38; therefore, 9 RCTs

Discussion

The available evidence suggests that synchronous telehealth alone or combined with in-person care is as effective and safe as in-person care alone for the nonpharmacologic management of chronic headaches; nonspecific low back pain; and knee, hip and generalized OA in adults.

Strengths of the included studies were large sample sizes in 5 of the 8 studies.25,35, 36, 37, 38, 39, 40,42 The quality of the evidence was low to moderate. This was primarily downgraded by the inability to blind

Conclusions

Our rapid systematic review includes 8 acceptable quality RCTs evaluating the effectiveness and safety of synchronous telehealth alone or in combination with in-person care for the management of nonacute MSK conditions in adults. Overall, we found evidence that videoconference or telephone calls alone or in combination with in-person usual care were as effective and safe as usual in-person care alone. Our findings suggest that telehealth may be a solution to inaccessible in-person clinic-based

Supplier

Excel (2019); Microsoft Corp.

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    Disclosures: None.

    This study was supported by a research agreement between the College of Chiropractors of British Columbia and Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct, or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté, who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and funding from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.

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