Lessons from the pandemic: a retrospective study and literature comparative review of provider and patient experiences with telemedicine in spine care

Abstract

Objective: Telemedicine use for patient care in spine surgery drastically increased after the advent of the COVID-19 pandemic. The authors aimed to examine factors influencing telemedicine utilization during this period by comparing perspectives from patients and spine surgeons to better guide the use of telehealth beyond the pandemic.

Methods: Between June 2021 and December 2021, a survey was administered to spine care patients receiving virtual visits at a single multidisciplinary spine center to assess their telemedicine experience, including visit quality, overall communication, and technical challenges. Furthermore, a systematic review using the PubMed, Google Scholar, Embase and Web of Science databases in accordance with the PRISMA guidelines was conducted to identify survey studies of spine surgeons and patients assessing telemedicine experiences.

Results: A total of 407 patients were included in our survey; 65.6% were female, and 82.8% were at least 55 years of age. Most patients were White (86.2%) and had at least a bachelor's degree (81.6%). The majority of respondents (96.8%) reported being satisfied or very satisfied with their telemedicine visits. Explanations at the end of visit (p < 0.001), time spent during the visit (p < 0.001), and absence of technical issues (p < 0.001) were significantly associated with increased patient satisfaction. Barriers to access such as education level, age, or race were not significantly associated with patient satisfaction (p > 0.05). The authors also performed a systematic review that identified 10 studies on patient attitudes toward telemedicine with 3569 respondents in North America and 10 surveys of spine surgeons with 3043 respondents internationally. Most telemedicine visits were pre- or postoperative (56.3%, 1914/3399; range 42%-95%), and the majority of patients reported traveling less than 25 miles for in-person visits (63.3%, 815/1287; range 57%-68%). Nine patient studies revealed a high patient satisfaction level with telemedicine (79.7%, 2248/2821; range 36%-93%). The virtual physical examination was of greater concern for surgeons (48.6%, 433/891; range 10%-91%) than for patients (15.5%, 156/1007; range 2%-74%).

Conclusions: This study highlights the high level of patient satisfaction with telemedicine in spine care, emphasizing factors including clear explanations, sufficient time during visits, and minimal technical issues. Despite concerns about the virtual physical examination, especially among surgeons, telemedicine was effectively utilized for pre- and postoperative care. Telemedicine can continue to play a valuable role in spine care beyond the pandemic, provided that technical challenges are addressed, and communication remains clear and thorough.

Keywords: COVID-19; infection; spine surgery; telehealth; telemedicine.