The following blog is written by a student physiotherapist in their final year. They asked a question which in order to help their learning, was passed back to them. Their question was; could it be online? The student is on a placement ibn a community rehab team, which means they visit patients in their own homes. These patients might have either been referred after being discharged from hospital; perhaps after an operation. Or they may have been referred by their GP. The intention of the team is to work with patients who have musculoskeletal or MSK related issues and need help. Anything outside of that remit would normally be referred to a specialist team. It’s over to them:-

Online Versus Face to Face

I was asked a question by my practice educator, that’s the physiotherapist who’s guiding me through this placement. I had told him I had a particular interest in telehealth care and the delivery of physiotherapy through online services. So I had asked him what he thought of online physiotherapy. He paused for a minute and then said “Observe each interaction today and at the end you can tell me which, if any could have been online”.

Practice Makes Perfect

As a student we observe a lot and also get the opportunity to work with the patients ourselves. I find that on entering a patients home, I am often distracted by everything in the home. Looking around at peoples belongings, chatting to relatives and stroking or avoiding cats and dogs, it can be a challenge to concentrate. 

I wanted to make sure I was able to answer the question well so I got out my note book and pen and prepared myself. Observing and then doing is a great way to learn, especially in a career like physiotherapy. It is a hands on profession after all. Or is it? I guess that’s the purpose of the question, could it be online?

The residential Patient

The first patient lives in a residential home, sadly she had recently had a fall which had resulted in a fractured knee. There had been no need to operate but the consultant had supplied her with a specific type of leg brace. Residential homes have less focus on nursing and more on supporting residents.  Our visit was mainly to show the care staff and the patient how to fit and remove the brace and to assess the patients mobility. 

My educator asked me if I’d fitted this type of brace before, to which I replied yes. More fool me, suddenly there were six care staff, the patient and my educator in the room all watching me! Thankfully I made it look easy and guided the staff through taking it on and off. So to answer the question: Could it be Online? Due to the need to demonstrate the brace NO. 

Community Variety

They say that variety is the spice of life and it’s definitely true of working in the community. You are faced with so many different scenario’s that it takes a certain type of person to do the job. You need to be adaptable to any situation. One minute you’re in a well healed area, the next you might be dealing with a patient who has very little and the contrast can come as a shock.

The next patient had been referred by their GP having had a number of falls. Thankfully she had managed to avoid any fractures and had only suffered soft tissue damage. I was given the chance to work with her and I conducted a number of what we call ‘special tests’. These give an insight into which muscles or area might be affected depending on how the patient responds. Based upon what I observed I recommended some exercises to the patient and showed her how to do them. Could it have been online? Definitely YES

On Balance

The next patient was pleased to see us. She had recently come home from hospital having just had a had hip replacement. Hip replacements come in a variety of types depending on the patients need and state of the femoral head and pelvic socket. This patients was what is called a Hemioplasty. A straight forward op with no restrictions post operatively on range of movement. We observed her, sitting standing and walking. She even managed to go outside! We then discussed exercises and I ran through them with her. 

Could it have been online? In terms of patient safety, it was necessary that we saw this patient face to face to check she was safe and stable, however seeing how strong she was, going forward her following appointments could easily be online. NO and YES

Last But Not Least

The final patient for me (it was a half day!) had been referred also by a GP, the gentleman had been off work for sometime as he had broken his leg. Much like the first call of the day, he was wearing a hinged knee brace. My educator had seen this patient several times before. The patient was able to don and doff the brace himself, was completely independent with it and was following his exercises diligently. To say he was keen to hear from the consultant and toget the brace off was an understatement! As this was the 4th or 5th appointment for this patient and he was progressing nicely, this could absolutely have been done on line. YES

So Can It Be Done on Line?

The answer is, it depends on the individual and the nature of their case. The community team do an amazing job and it’s been a great experience working with them. Some of their services could definitely be done online as long as it ran alongside their current service. What is obvious is there are a large number of conditions particularly musculoskeletal, that could easily be online and referred by the GP. These would shorten waiting times, free up the community and outpatients physios and give the patients quicker access. It’s not currently something that is standard in the NHS but is available privately.  For those that can afford it, it could definitely be worth taking this route and helping freeing up NHS resources. 

As a soon to be physio, it free’s up time, makes it easier to focus with less distractions and you have all of your resources at your finger tips. I hope that face to face is always part of what we do, but I can definitely see the benefit and would embrace doing both.