Studies completed by: Michaela Kopka MD, FRCSC, Laurie Hiemstra MD, PhD, FRCSC, Julie-Anne Frayn PhD, Sarah Kerslake MSc, PT.
Presented by: OrthoEvidence
Interview with Michaela Kopka MD, FRCSC
The COVID-19 pandemic has significantly impacted the normal operation of orthopaedic surgical procedures. This delay poses a serious risk to the health and well-being of patients whose scheduled surgery has been postponed and also those requiring post-surgical care amid the pandemic. Banff Sport Medicine (Alberta, Canada) conducted two studies to investigate the impacts of COVID-19 closures on orthopedic surgery-related care.
To explore the impacts of the COVID-19 pandemic on patients due to postponement of their orthopaedic surgery.
An electronic questionnaire was distributed on May 9th 2020 to Banff Sport Medicine patients who had their surgeries postponed because of the operating room closures due to COVID-19.
Of 269 patients who received the questionnaire, 148 (55%) returned the results and 137 (53.1%) provided complete responses (Figure 1).
More than 90% of the respondents were 18-64 years of age (90.7%). The most common three surgical procedures that were postponed surgical procedures were anterior cruciate ligament reconstruction, shoulder stabilization and knee arthroscopy for meniscal injury. Following surgery postponement, 40.3% (56/139) of the respondents indicated that their symptoms were getting worse in some way and 65.5% (91/139) felt the postponement has negatively impacted their physical health. Delay of surgery took an emotional toll on patients with 73.3% of patients reporting negative feelings and 69.1% reporting a negative impact on their overall emotional and physical health. The feelings identified were largely negative with 85.5% (119/139) described as anxiety, anger, and frustration. In addition, 60.4% of patients indicated there will be negative effects on their ability to return to work, and 85.6% of patients indicated there will be negative effects on their ability to return to sport and leisure activities. Among the 112 respondents who had been experiencing pain as a result of their conditions, 48.2% (54/112) were suffering increased pain. By asking the respondents to rate their pain change on a 0-10 scale (0 being no pain, 10 being the worst pain possible), 40% (42/105) of respondents had an increase in pain of at least one point on the scale. Using the EQ-5D-5L instrument, experiencing pain/discomfort (81.2%, 112/138) and having problems in usual activities (65.9%, 91/138) were reported by the majority of respondents (Figure 2).
Patients have been negatively impacted by the postponement of non-urgent orthopaedic surgery due to the COVID-19 pandemic. Affected patients have reported increased pain, reduced function and negative emotional consequences of postponed surgeries, as well as the effect of delayed surgery on patients’ ability to work and be physically active.
To investigate the effects on patients following their orthopedic surgeries of the surgeons’ office and physiotherapy closures due to the COVID-19 pandemic.
An electronic survey was sent on May 9th 2020 to Banff Sport Medicine patients who underwent surgical procedures within the 3 months prior to the COVID-19 related shut-downs (The province of Alberta mandated postponement of all non-urgent surgical procedures on March 16th 2020).
Of 476 patients who received the questionnaire, 208 (43.7%) returned the results and 198 (41.6%) provided complete responses (Figure 3).
Close to 95% of the respondents were between 18 and 64 years of age. The three most common surgical procedures which the respondents underwent within the 3-months prior to the COVID-19 related shut-down were anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, and knee arthroscopy. Out of 200 respondents, 44% (88/200) indicated that they believed that their recovery was delayed, and 70% reported that COVID-19 related shut-downs had negatively affected their recovery in some way. Limited access to physiotherapy was the leading barrier that respondents were concerned about in their recovery (64%, 128/200). After surgery, 42% (84/200) of respondents completed appointments with their physiotherapist virtually and only 43.9% indicated that virtual physiotherapy was helpful. As a result, 73% (146/200) believed their recovery was negatively impacted due to the lack of in-person access to physiotherapy. Interestingly, only 38% (76/200) of respondents considered their recovery negatively impacted due to the lack of in-person follow-up with their surgeons. The majority of feelings expressed by patients about the lack of post-operative care and follow-up (81%) were negative. Most respondents (64.5%) reported that they experienced increased pain or other symptoms as a result of the limited post-operative care. Using the EQ-5D-5L instrument, experiencing pain/discomfort (76.9%, 153/199) and having problems in usual activities (56.3%, 112/199) were reported by the majority of respondents. However, fewer respondents indicated any difficulties in mobility (28.1%, 56/199), self-care (8%, 16/199), or emotion (anxiety/depression, 34.7%, 69/200) (Figure 4).
Following surgery, limited access to physiotherapy, which usually requires person-to-person contact between patients and physiotherapists, was the leading perceived barrier for patients completing timely and appropriate rehabilitation.
Implications of the two studies
To our knowledge, these two studies are among the first to address the access to care limitations due to the COVID-19 pandemic. The studies report on the burden of surgical delays, and lack of surgeon and physiotherapist contact for those within 3-months of surgery, in an orthopedic setting in Canada. Study one highlights the reality that orthopaedic procedures have a profound effect on the physical, emotional health and ability to work for patients with musculoskeletal injuries. Study two highlights the importance of post-operative rehabilitation to maximize results for orthopaedic procedures. These studies provide important information to guide the re-opening of operating rooms, as well as how and when the back-logs of restorative orthopaedic procedures should be addressed.