sports medicine, steroid injections, privacy, confidentiality, public health data, consent, COVID-19, records review, musculoskeletal steroid injection patients
In sports medicine clinics, musculoskeletal steroid injection is a common intervention for patients with severe musculoskeletal pain, such as that from inflammatory arthritis, noninflammatory arthritis, bursitis, tenosynovitis, and carpal tunnel syndrome.1 This approach is known to help control debilitating inflammatory joint disease by improving joint function and accelerating return to daily living and work.1 This low-risk outpatient procedure is also useful for diagnosing some diseases, such as subacromial bursitis, a benefit which proved useful during the global COVID-19 pandemic when all elective cases were delayed.1 At the beginning of the pandemic, however, broad international guidance (issued in March 2020 and updated in November 2020) recommended that the use of musculoskeletal corticosteroid injections be limited to severe symptoms after failed physical rehabilitation and splinting, fearing the risk of COVID-19 and influenza infection and complications from immunosuppression.2,3
A retrospective study examined the risk of contracting COVID-19 within a 3-month period in 1,105 patients who received steroid or nonsteroid pain interventions at a sports medicine clinic in a Southeast Asia country. Previous research showed that steroid levels persist up to 12 weeks after musculoskeletal injection.4 Following approval from a designated ethics committee, the researchers recruited participants using electronic medical records containing lists of patients that had received pain interventions in the sports medicine clinic. Reasoning that interviewing each patient by phone to determine their COVID-19 history would have been time consuming and considering that patients may feel uncomfortable discussing sensitive and confidential information such as COVID-19 status, the research team obtained individuals’ COVID-19 status from an available data registry in coordination with the government which controlled the registry.
The study’s findings revealed that of 1,105 patients, 18 patients were identified as testing positive for COVID-19 within the time frame, and only two were identified as testing positive for COVID-19 after musculoskeletal injection. Telephone interviews were then conducted with the two patients to collect more information about their COVID-19 history, including date of first positive swab, location of swab, date of admission, number of admission days, history of intensive care unit admission, and history of death (of any family members) due to COVID-19. Informed consent was obtained for the interviews using a Google form.
Questions
The researchers decided to collect information from medical records to identify individuals who may be eligible for their study. What do you think about this practice? When might it be acceptable and when might it not be acceptable to do this without patient consent?
The researchers were given direct access to public health COVID-19 testing data for their study. What do you think about the ethical appropriateness of this, given the justifications provided by the researchers?
If you were involved in developing guidelines for researcher access to similar infectious disease testing data, what would you recommend be included in those guidelines to support ethical practices?
The researchers obtained informed consent from the two patients who were interviewed. Was there anyone else whom they might have approached for permission or consent at other points in the study?
