Technology can help you deliver your physiotherapy services remotely during the coronavirus pandemic and beyond. We summarise the challenges and opportunities with tips for using technology effectively and appropriately.
Providers of all community care must consider if remote consultations can allow for services to be provided without any physical interaction. This may free up more time to spend with those we need to see in-person.
- Maintain your record keeping standards.
- Minimise the identifiable information you share digitally.
- Record your patient conversations - including the advice/treatment you give and anything that you are unable to do because of the method of delivery. So, if you want to do a physical assessment but are unable to do so, record this and discuss it with your patient.
NHSX has produced detailed Covid-19 information governance advice which is valid throughout the UK. If you are working in England they also provide an IG portal where you can search FAQs and pose specific questions. Members elsewhere in the UK should seek local information governance guidance.
NHSX have also produced and MSK digital playbook with a number of resources to support remote delivery of MSK services. Although designed for MSK services there will also be parts applicable to other specialties and service delivery models.
The HCPC produced additional regulatory guidance to recognise that professional decisions will be made in different settings using different tools during Covid-19. This is to give confidence that professional judgement is given context in the unfortunate situation that any challenge be made to your practice.
Regardless of method of service delivery, it is essential that you recognise serious pathology which requires urgent and/or emergency referral to secondary care. Serious pathology could be a differential diagnosis if a person presents with new, escalating or progressively worsening symptoms. Serious pathology presentation is rare but when it does occur urgent and/or emergency escalation is required in line with local pathways. Although NHS England issued this serious pathology guidance (red flags) it is valid throughout the UK.
Digital tools for different scenarios
We have tried to consider all the scenarios that you may face during this challenging time. Our focus is on the additional tools that you might consider, beyond phone calls, emails and texts. If we have missed any tools or scenarios please get in touch. We will review and update this page regularly and in line with any new government advice.
I need to be able to stay in touch with my team…
Consider WhatsApp, Slack, Facebook groups, Skype for business or Microsoft teams. Also, Hospify, an app recently added to the NHS England App library supports secure messaging between clinicians. Unlike the other examples its level of data security allows for patient identifiable information to be shared.
I just need to be able to talk with my patient…
Pick up the phone! Just remember to record your conversation in the clinical notes as you would a face to face conversation. The CSP has issued guidance for telephone triage in an MSK setting although large parts of it are useful in other physiotherapy specialties and settings.
I need to see my patient but not regularly…
Consider WhatsApp, FaceTime, Facebook Portal or Skype for remote consultation, especially if you need to do this only on an infrequent basis. Consent is implied by your patient accepting an invite and joining the consultation.
I need to see my patient on a regular basis…
You can explore products like Attend Anywhere for remote consultation. You can find guidance for setting up clinics using Attend Anywhere in primary care, inpatients and outpatients.
I need to provide group therapy on a regular basis…
For those appropriate symptoms, conditions and patients you can explore products like Skype for business or Zoom for remote class delivery. If you don’t need class interaction then explore sharing the video on a website, by recorded webinar or posting via WhatsApp, Facebook groups etc. Patients can then follow these in their own time.
I need to work from home…
See our advice on working remotely if you are able to work from home. You may need to use your own devices if there is no practical alternative. Again follow the CSP and IG advice as above.
I need to get information to my patients but don’t need contact with them…
For supported self-management of appropriate patients you could host videos or advice on your website, run webinars or use group communications like Facebook or WhatsApp. You can either keep these groups closed or have them open to give public health advice as demonstrated by NHS Ayrshire and Arran in Scotland.
I need to continue with my physiotherapy research…
Members must of course prioritise patient care and frontline services at this time and latest advice from major research funders and government bodies can be found here. If you are continuing with research then you may need to think about how you will need to change your protocols in order to deliver it within the current climate for example: you may want to consider mobile messaging or explore tools such as FaceTime, Skype, Microsoft Teams. There is a closed Facebook group for health professionals in research that you may wish to use. It is important that you also review your ethics approval and re-submit as required.
Other related resources…
There are also apps for patients to track symptoms, adhere to prescribed exercises and much more. The CSP has launched an app library, supported by ORCHA. They review a huge number of healthcare apps and give ratings on data security, clinical evidence and user experience. This will allow CSP members to confidently recommend appropriate apps to patients to support self-management during Covid-19 and beyond.
The Physiotherapy Evidence Database (PEDro) collates evidence from systematic reviews to guide remote delivery of physiotherapy.
The Early Intervention Foundation have produced a report on the evidence, challenges and risks relating to virtual and digital delivery.
A summary of some of the digital tools has been created by Ben Wanless, a member of the Digital and Physiotherapy Informatics Group (DIPG), and included below. Although written for MSK services it is definitely transferable to other specialities.