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Corso M, Cancelliere C, Mior S, et al. 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. Arch Phys Med Rehabil. 2022 Jan;103(1):145-154.e11. doi: 10.1016/j.apmr.2021.09.007. Epub 2021 Nov 2. (Systematic review)
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.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
Comments from MORE raters

Physician rater

As we are all impacted my C-19, it is reassuring to find that tele-medicine is a viable alternative to in-person consultations.

Physician rater

With changing options to deliver care, more studies will be needed to determine safety and efficacy with telemedicine. This study was chiropractic based but does have some crossover with family medicine.

Rehab Clinician (OT/PT) rater

I find it very curious that a group of chiropractors are evaluating research that predominantly involves PT and neurology but no chiropractic interventions. Furthermore, there appears to be a conflict of interest in that the College of Chiropractors supported this study, and it appears to be motivated by the College's need for guidance around COVID restrictions. Given that chiropractors are private businesses and not part of publicly funded health care, I would consider this a major undisclosed bias in this study.
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