Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness

Abstract

BackgroundVideo consultation was implemented as a new service in a hospital hand therapy setting. PurposeTo describe the first year’s practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. Study DesignIterative design including economic evaluation. MethodsUsing the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients’ municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. ResultsOf 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. ConclusionsThe results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.