Like all of my colleagues, in March 2020 I had to reconsider how to deliver physiotherapy practice.
Before 2020 I only knew two physiotherapists who offered virtual sessions, and all of our NHS appointments were face to face.
The CSP advised that providers of care should consider if remote consultations could be used to conduct sessions without physical interaction. They suggested using “virtual triage” to decide how to interact with patients. However, I was cautious about offering virtual assessment and treatment.
Getting hands on and feeling the musculature, the joint the movement is a large part of my practice, this is all invaluable, as is building personal connections with the individuals I treat. Manual therapy is a large part of my practice, the patient is your biggest tool, as is building personal connections with the individuals I treat.
I could not see how to deliver my sessions online andgive the same value. Yet the situation was, quite literally, out of my hands. So I had to try.
The main thing was talking to my patients, doing that virtual triage and finding out what they wanted and what concerns they had. There was skepticism about how sessions would work, as well as the safety and reliability of online videos.
There are clear drawbacks to delivering sessions online. I don’t feel as effective as I am not getting the same hands on feedback. Also, not everyone has access to equipment to do the exercises, there is a socio-economic gap in access to gyms and other facilities, or being able to have equipment in your home. Technology wise, you need to set it up correctly. Camera angles, connection issues, and slow internet means you cannot see properly and offer the correct advice, it also takes more time to confirm.
In my opinion, there have been improvements in clinical effectiveness since going virtual. Attendance has increased hugely - up to around 90%. Whereas people would miss appointments previously, due to work commitments, price of parking or public transport, being late due to traffic.
Now, being able to attend from home means people turn up, on time, and the appointments are much quicker - which means we can actually see more people in a day.
This has translated into reduced waiting lists and waiting times, meaning we are able to see people sooner after injury and those with low grade injuries can get appointments more readily. Hopefully we will see this reflected in better outcomes in the long-run as we can get them moving, strengthening, and progressing sooner. MSK is also changing and we are looking at more than medical management, but also social approaches and subjective history. Seeing people in their own homes means they are more relaxed, we can understand their environment better and even address things like working positions accurately as we can see their work setup.
There have also been benefits for me as a clinician, with an emphasis and improvement on clinical reasoning. I have more time and I can dedicate this to working more directly with other practitioners - understanding things better and unlocking things that I may not realise on my own. A fellow sports professional Danny Donachie, Director of Medical Services at Everton FC, found a similar experience for them at the club: “There’s a lot more benefit to going virtual than I had realised. We have maintained face to face support for the players, however what we have been able to do during lockdown is bring together various stakeholders across the club - it is now a lot easier to get everyone together to speak about individual players as a medical team. One challenge was that we had planned a new education programme for the staff. Now the teaching is much more accessible, I have a sports scientist from Australia delivering a 2 hour presentation. When you realise how much more accessible virtual is, it opens up a whole new opportunity.”
After 6 months of virtual practice, here are my top considerations for other physiotherapists:
There are some downsides you need to consider, like patient access to equipment and being unable to get hands-on, address these and think about other ways of working your sessions - such as household items as weights and resistance.
Technology is a great tool for prolonged treatment, if you get it right - Pre- appointment ask your patient to test angles so you can see joints, the whole body and any equipment. Moving the camera around can help show mobility throughout range. High speed internet, the faster the better, and a camera with high frame rate means better visibility.
There are more opportunities to work together and learn from each other, thanks to the shift online - you can create a new MDT, learn from peers, or access international training like never before.