SCiP: Supporting Consultations in Remote Physiotherapy
WHY THIS IS IMPORTANT:
Video consultations using Teams, Zoom and similar technologies have been rapidly introduced across the NHS during the COVID-19 pandemic. Video now plays a potential crucial role in physiotherapy: for a good consultation, physiotherapists need to be able to see how patients move. In recent years, researchers have developed some support for patients, such as the Telerehab Toolkit. However, there is limited guidance for patients and physiotherapists on communication over video.
In previous research, we developed a range of resources to help patients and clinicians with video consultations. The NHS has enthusiastically taken up these resources. To support spread of video consulting in physiotherapy services (and more widely in the NHS), we plan to adapt and update these resources in ways that can support use of physical examinations in video consultations.
We want to understand how clinicians do physical examinations in video consultations for physiotherapy, and develop guidance on remote physical assessment that can help patients and clinician use video consultations in the wider NHS.
We video-recorded 15 video consultations and interviewed 22 patients and physiotherapists in three services: orthopaedics, pain management, and neuromuscular rehabilitation. We transcribed these recordings to analyse the verbal and non-verbal communication strategies used by patients and clinicians. Using established research methods helped us understand how they use language and their body, as well as the technology, to complete a physical examination.
We found that patients and physiotherapists are generally satisfied with video consultations. They manage to complete a range of physical examinations, which makes it possible for the physiotherapist to assess the patient’s progress and for the patient to demonstrate exercises and learn new ones.
For video to work well, though, our research highlights three specific challenges. First, patients need to be safe and comfortable moving around in their own environment. Many patients are fine to do basic movements on their own, but some patients may have mobility difficulties, and this can create a risk of further injury. Second, the patient needs to be able to show their body using the camera. The camera offers only a limited view, and it can be difficult for patients to frame themselves in a way that the physiotherapist can adequately see what they are doing. Third, patients and physiotherapists need to be able to establish how the patient’s body feels or should feel. The language used by physiotherapists is not the same as that of patients and patients do not always have adequate body awareness. Good communication is vital for making this work.
HOW THIS WILL BENEFIT PATIENTS:
We engaged with members of the public, patients with lived experience, and physiotherapists through workshops and focus groups to understand their perspective and what tools they need to help them have better video consultations. With Design Science, we organized a series of co-design workshops (with patients) to develop illustrated resources to support patients and physiotherapist communicate over video.
The resources are now available for patients and physiotherapists. We are currently working with national stakeholders (for example, NHS England, the Chartered Society of Physiotherapists) to make these resources as widely available as possible and support those designing, delivering and receiving remote physiotherapy services.
CONCLUSIONS AND FUTURE PLANS:
Even without the ability to lay hands on the patients, video consultations can be a good option for some patients in physiotherapy, especially for routine follow-up. With training and support, they can overcome the perceived limitations of the technology. Many patients prefer a hybrid service model, in which they mainly consult over video and occasionally go to clinic. We plan to further examine the feasibility and acceptability of video consultations, and how it can lower or raise the barrier for accessing healthcare, particularly among marginalized communities.