HumanInsight Digital health applications to establish a remote diagnosis for orthopedic knee disorders: a scoping review
J Med Internet Res. 2022 Dec 23. doi: 10.2196/40504. Online ahead of print.
BACKGROUND: Knee pain has a high prevalence globally and it is expected that this number will rise in the future. The COVID-19 outbreak in combination with the aging population, rising healthcare costs and the need to make healthcare globally more accessible leads to an increasing demand for digital healthcare applications to deliver care for musculoskeletal patients. Digital health and other forms of telemedicine can add value in optimizing healthcare for patients and healthcare providers. This might reduce healthcare costs and make healthcare more accessible whilst maintaining a high level of healthcare. Although the expectations are high there is currently no overview of the applications that compare digital health applications with face-to-face contact in clinical trials to establish a primary knee diagnosis in orthopedic surgery.
OBJECTIVE: The aim of this study was to investigate the currently available digital health and telemedicine applications to establish a primary knee diagnosis in orthopedic surgery within the general population in comparison with imaging or face-to-face contact between patient and physician.
METHODS: A systematic scoping review was conducted in the PUBMED and EMBASE database according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) statement. The inclusion criteria were studies reporting methods to determine a primary knee diagnosis in orthopedic surgery using digital health or telemedicine. On the 28th and 29th of April 2021 the search was performed in the PubMed (Medline) and EMBASE databases. Data charting was conducted via a predefined form and included details on general study information, study population, type of application, comparator, analyses and key findings. A risk of bias analysis was not deemed relevant considering the scoping review design of the study.
RESULTS: A total of 7 articles was included after screening 5639 articles. Two categories to determine a primary diagnosis were identified: screening studies (n=4) and decision support studies (n=3). There was a large heterogeneity in the included studies in used algorithms, disorders, input parameters and outcome measurements. No more than 25 knee disorders were used in the included studies. The included studies show a relatively high sensitivity (67-91%). The accuracy of the different studies was in general lower with a specificity of 27-48% for the decision support studies and 73-96% for the screeining studies.
CONCLUSIONS: This scoping review shows that there is a limited amount of available applications to establish a remote diagnosis for knee disorders in orthopedic surgery. To date there is limited evidence that digital health applications can actually assist a patient or orthopedic surgeon in establishing the primary diagnosis for knee disorders. Future research should aim at integrating multiple sources of information, standardized study design with close collaboration between clinicians, data scientists, data managers, lawyers and service users in order to create reliable and secure databases.
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