During the COVID-19 lockdown from March to July 2020, the department of a European Level 1 trauma center offered selected patients, for whom one-on-one therapy was not medically imperative, the option of telemedicine follow-up or physical therapy in lieu of a one-on-one consultation. Patients included in this study consented verbally to telemedical care and had the technical requirements (ie, smartphone, computer, or phone) and expertise (subjectively) needed to attend the telemedical consultation. The telemedical follow-up or physical therapy took place either as a pure telephone consultation or as a videotelephone consultation by means of a smartphone or computer with integrated video function, where the patient could demonstrate findings such as wounds and range of motion to the treating therapist, or the therapist could instruct the patient on appropriate physiotherapeutic exercises.

Patients who medically required a one-on-one consultation, those who were declined telemedical follow-up or treatment, or could not meet the technical requirements for other reasons, such as not owning a smartphone, tablet, or computer, or not having an internet connection, were excluded.

Patients who received a telemedical follow-up or treatment were called by phone and asked to retrospectively complete a standardized patient satisfaction questionnaire (Freiburg Index of Patient Satisfaction) in relation to the treatment that had taken place after the postoperative treatment was ended. In addition, they were asked what type of device they used for telemedicine consultations and whether they are familiar with using smartphones and tablets. The questionnaire and the additional question were then completed during the telephone call as part of a standardized interview.

The standardized questionnaire used in this study was the Freiburg Index of Patient Satisfaction (FIPS) questionnaire, which was developed in 2013 by Miernik et al [13] to assess treatment-related patient satisfaction. The questionnaire can be used across disciplines and regardless of the type of interventional or operative treatment. The questionnaire consists of 5 questions, called items, which are assessed using a 6-point scheme. Questions 1 to 4 can be rated on a scale from 1 (strongly agree) to 6 (strongly disagree). Question 5 can be rated on a scale from 1 (excellent) to 6 (very poor). The sum value of the points awarded is divided by the number of items after all questions have been answered, resulting in an overall score, the FIPS score. The FIPS score is thus between 1 and 6, with 1 corresponding to an excellent score and 6 to a very poor score. With the help of a regression analysis, Miernik et al [13] were able to show that neither the invasiveness of the procedure nor sociodemographic factors, such as age, gender, or school leaving certificate, have any influence on patient satisfaction. The independence of sociodemographic factors is very unusual, as they have been shown to be influencing factors in many studies. This underlines the ubiquitous applicability of the FIPS questionnaire [13-15].

The questionnaire is formulated in a way that is very understandable for everyone and can therefore be answered completely by almost all patients independently. The FIPS questionnaire is considered valid, reliable, and one-dimensional, meaning that it only focuses on subjective patient satisfaction [13]. However, patient satisfaction alone cannot provide a final verdict on the quality of a treatment or therapy, as it provides a subjective picture. Nevertheless, it is an important parameter for establishing a comprehensive quality assessment of a treatment. For the optimal validity, patient satisfaction as well as clinical parameters or scores should be included in the overall assessment.

Further statistical analysis was performed with the use of IBM SPSS Statistics for Mac (version 26.0; IBM Corp). Data are presented as frequencies (n) and means with SDs. To assess differences in ordinal data between the groups, a nonparametric median test and a chi-square test for nominal data were used. A subgroup analysis was performed for the age groups (<65 years vs ≥65 years), gender, and the used device. The level of statistical significance was set at P<.05.

The local ethics committee (Kantonale Ethikkommission, Kanton Zürich) ruled that no ethical approval was necessary for this study (BASEC-Nr. Req-2020-00562).

In total, 25 patients (14 female) with a mean age of 43 (SD 24.31; range 14-95) years were included. Of them, 7 patients were 65 years or older. Most patients (n=19, 76%) used a smartphone for the telemedical consultations, 4 (16%) used a computer, and 2 (8%) used a landline phone. There was no difference between female and male patients (P=.42) and between age groups (P=.06).

The results of the FIPS Questionnaire can be found in Figure 1 and Table S1 in Multimedia Appendix 1.

Additionally, we found a mean score of 1.64 (SD 1.49; range 1-6) regarding electronic device familiarity among all patients. The vast majority of the surveyed patients (n=20, 80%) were absolutely confident with their smartphone or tablet use. There was no significant difference between female and male patients (P=.23). There was also no difference between younger and older patients (P=.08). Regarding device use, there was no significant difference between the groups (P=.11; Figure 2).

The aim of this study was to investigate satisfaction with telemedical consultations in patients with orthopedic trauma during the COVID-19 pandemic. The answers of the 25 included patients to the FIPS questionnaire showed very positive results, reflected by an average FIPS score of 2.14 (SD 0.87). Interestingly, patients older than 65 years of age scored in the “burden of treatment” question significantly better than their younger counterparts. Furthermore, they scored the treatment in almost every item of the FIPS better than patients younger than 65 years of age. This is interesting, since other studies suggest that older patients are rather less interested in telemedicine than younger patients [5,9]. Interestingly, patients aged more than 65 years stated that they were less familiar with their electronic devices than younger patients but rated a better score for the actual telemedical treatment. The authors suggest that this indicates the easy use of telemedical devices after treatment, showing that it does not require advanced technical skills. This is all the more true for smartphones, which have become widely used in all social classes and age groups in recent years. This could be one explanation why smartphone users and also landline phone users rated the success of the therapy significantly better than their counterparts who used a computer. No significant differences between male and female patients were found in our study. Male patients showed slightly higher confidence with their electronic devices and showed a slightly better FIPS rating than female participants. This is contrary to several studies, which showed higher use of and satisfaction with telemedicine in female patients [12]. However, a recent study on telemedical use during the COVID-19 pandemic showed findings similar to our study. Ramaswamy et al [16] assessed that younger age and female gender were associated with lower satisfaction after telemedical treatment. However, they were also able to show that during the COVID-19 pandemic, patients treated with telemedical solutions showed higher satisfaction compared to one-on-one treatments. This result supports the idea of introducing telemedical consultations with videotelephony as an alternative to one-on-one consultations. These findings as well as the results of our study suggest that telemedical solutions are valid options in terms of cost-effectiveness and travel times and especially in times of a pandemic when personal contact avoidance is desired. To our knowledge, no such findings have been described in the current literature.

This study has certain limitations. It is well known that surveys have minor levels of evidence, and the outcome of this study is directly connected to participant’s understanding of the questionnaire. Although there are clear trends seen in our results, these findings should be treated with caution, considering the broad age spectrum and the very diverse patient population. Patients selected for a telemedical consultation were required to have the necessary prerequisites, such as internet connection, a telemedicine-enabled digital device, and the expertise needed to operate it. This causes a certain bias in the results obtained, as patients were already selected and were sympathetic toward telemedical consultations.

As another limitation, it may be noted that we did not focus on patients with a specific injury and included patients with different patterns of injury. However, because the focus of this study was on overall patient satisfaction with telemedical treatment regardless of injury pattern, we consider the inclusion of patients with different injury patterns to have a negligible bias on the significance regarding patient satisfaction.

In addition, the limited number of included patients limits the generalizability of the statements. However, the statistically significant findings can be considered highly significant with such a small cohort.

The majority of patients surveyed stated a high satisfaction with the telemedical follow-up. The results of this survey showed a positive trend in patients’ attitudes toward telemedicine in both age groups, with a higher satisfaction rate in the group of older patients.

It seems that telemedical postsurgical or physiotherapeutic care is a viable option, especially in times of reduced contact, like the current COVID-19 pandemic. Our study is another component to fill the gap in the available literature on telemedicine in the treatment of patients who experience orthopedic trauma.

Further studies should include a larger number of patients and focus specifically on different trauma entities. Furthermore, a matched-pair analysis, assessing differences between telemedical aftercare and conventional aftercare, should be performed.