Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS

Figures & data

Table 1. Detailed methods of assessing CRPS signs by physiatrist.

Sensory	To evaluate for hyperalgesia, the patient or their companion touched the affected limb with a sharp object and the patient noted whether an increased pain response was elicited. To evaluate for allodynia, the patient or their companion applied a light touch to the affected limb. Altered sensation/paresthesia was assessed by applying an identical force to both a CRPS-affected area and a corresponding non-CRPS-affected area on the contralateral extremity; the patient was then asked to comment on any perceived difference in sensation.
Vasomotor	Temperature asymmetry was assessed without specialized equipment. If a companion was present, that person was asked to touch both the patient’s CRPS-affected limb and contralateral non-CRPS-affected limb simultaneously to assess for temperature discrepancy. If unaccompanied by a companion, the patient was asked to stroke their face with both hands or arms simultaneously (all participants were affected by upper-limb CRPS). Skin color changes were determined by visual comparison between CRPS-affected and non-CRPS-affected areas.
Edema/sudomotor	Edema was evaluated by looking for signs of generalized swelling and lack of normal skin wrinkles; at the knuckles, for example. Sudomotor signs (sweating changes or asymmetry) were considered by observing and comparing sweat patterns at a CRPS-affected and a non-CRPS affected region. Assistance from the patient was requested if the video image was not clear.
Motor/trophic	Active and passive range of motion of all proximal and distal joints of the affected limb was evaluated, with assistance from a companion for some participants. Weakness, defined as decreased strength relative to the unaffected side, was evaluated using whatever materials were readily available to the patient. Reflexes were not tested.
Other	The physician evaluated for increased or decreased hair and nail growth by visually comparing CRPS-affected and non-CRPS-affected areas, confirming with the patient that differences observed were not due to a nonnatural cause (i.e., shaving only one limb or cutting nails on only one side of the body). Skin changes were defined as the presence of shiny skin, brawny discoloration, or other observed asymmetries.

Figure 1. Body parts affected at original injury and at the time of referral for virtual evaluation of CRPS.

Table 2. Quantitative patient responses to questionnaire.

	Virtual hand therapy, n %	In-person hand therapy, n %	Virtual and in-person hand therapy, n %	No hand therapy, n %
Patients receiving hand therapy before physiatry assessment for CRPS, N = 13	6 (46)	1 (8)	2 (15)	4 (31)
Patients receiving hand therapy after physiatry assessment for CRPS, N = 13	7 (54)	1 (8)	2 (15)	3 (23)
	None, n %	Mild, n %	Moderate, n %	Severe, n %
Return of symptoms after treatment, N = 11	4 (36)	4 (36)	3 (27)	0 (0)
	Had used telehealth previously, n %		Had not used telehealth previously, n %
Patient exposure to telehealth prior to physiatry appointment, N = 13	4 (31)		9 (69)
	Yes, n %		No, n %
Would you recommend treatment of an injury similar to yours through virtual care?	10 (77)		3 (23)
Would you have preferred an in-person appointment if possible?	7 (54)		6 (46)
Did you encounter any barriers to engaging in virtual care? If yes, did you encounter the following: (a) Did not have a suitable device (b) Uncomfortable with the technology (c) Poor Internet connection (d) Other	2 (15) 0 (0) 0 (0) 1 (8) 1 (8)		11 (85)

Figure 2. Participant responses to 5-point Likert scale questions about experiences with virtual care.

Table 3. Compilation of participants’ qualitative responses.

Excerpts from participant free-text responses regarding the virtual care experience

“I am grateful for the treatment but believe a virtual diagnosis was not enough information for [the doctor] to truly know my condition. It was also difficult because we are extremely rural and our connection kept stalling and cutting out.”

“Virtual follow-up has been very successful, easy, and convenient. I feel very fortunate to have this care.”

“Seeing the doctor virtually is much more like actually having a visit than talking on the phone. If I cannot see the doctor, virtual is satisfactory/preferred.”

“I found virtual calls very reassuring and a big help.”

“It was very important to have access to professional and personalized treatment after my injury, especially with the background pandemic disrupting normal access.”

“I was very impressed with the virtual service. The assessment and treatment were great. I was fully confident in [the doctor’s] ability to assess me virtually. I would like to keep doing it this way.”

“It worked very well. It makes sense in that people do not have to travel from all over the place to see specialists.”

“My preference would have been an in-person consult/initial exam, but I understand that due to COVID it wasn’t possible.”

“I think telehealth is an amazing resource for remote communities.”

“So glad that I was referred to [the doctor] and virtual treatment was available. I highly doubt that I would have been able to get treatment had virtual consultation not been an option.”