Evaluation of remote physiotherapy delivery options

Remote physiotherapy delivery options are a component of digital physiotherapy and encompass all methods of providing physiotherapy where the patient is remote from the practitioner. Delivery methods include, but are not limited to, telephone, video, email, SMS, websites or apps. Remote physiotherapy delivery options can be used in triage, for assessment and diagnosis, to provide self-management information, for e-rehabilitation packages or for monitoring of long-term conditions, and they may have a different impact depending on the purpose.

Why is it important to evaluate remote physiotherapy delivery options?

The Covid-19 pandemic has necessitated a rapid growth in the implementation of remote physiotherapy delivery options and a need for services to evaluate these changes in provision.

Local evaluations, which are often small-scale, provide information within the context of local service provision, care pathways, and population needs.

Evaluation can provide information on the following:

  • Informing planning of physiotherapy services.

    By demonstrating the aspects of clinical care that work well using remote physiotherapy delivery and those that require in-person contact.

    By exploring how acceptable remote physiotherapy delivery options are to patients.

  • Minimising heath inequality.

    By identifying the patient groups for whom remote physiotherapy delivery is unsuitable or suboptimal.

  • Making the case for appropriate hardware and software.

  • Identifying training needs of staff in providing remote service delivery options.

  • Demonstrating the costs of remote service delivery options.

Examples of remote physiotherapy delivery evaluation

An evaluation should be designed to address specific questions about the service or intervention of interest [1]. So, the first step is deciding what question you want to answer about your remote physiotherapy delivery.

Here are a few examples of evaluation questions, with possible data requirements and some things to consider.

Example 1: What are patients' outcomes and experiences of our remote physiotherapy delivery?

  • Data examples: Patient reported outcomes and patient experience questionnaires.

  • Some considerations: The measures your service currently uses may be adequate to answer this question. Patient experience questionnaires may need adapting to ask about the type of remote delivery (e.g. telephone, video, email). Ensure data can be collected from patients who do not respond well to remote physiotherapy delivery as well as those who have good outcomes and satisfaction.


Example 2: For which patients or interventions are remote physiotherapy delivery options unsuitable or suboptimal?

  • Data examples: Recording the characteristics of patients for whom remote physiotherapy delivery was poor or was not possible. Staff recording the suitability of a digital contact for each patient.

  • Some considerations: Remote physiotherapy delivery may work well in some types of intervention (e.g. advice, self-management, exercise) but not others (e.g. physical examination, where patients need physical support). It is of paramount importance to collect data on patients for whom remote physiotherapy delivery is unsuitable to avoid increasing health inequalities. Some patient groups who may find remote options challenging are those: with cognitive impairments; with poor digital literacy; who do not speak the language of the practitioner; with hearing and/or visual impairment; without access to suitable devices or private spaces for remote treatment.


Example 3: Does the organisation or service have appropriate hardware and software to provide remote physiotherapy delivery?

  • Data examples: Staff recording of availability of digital devices, failed contacts due to connection issues, failed contacts by patients as they cannot access the mode of delivery e.g. a video platform.

  • Some considerations: The capability of systems to enable growing numbers of remote physiotherapy delivery options may be a barrier to successful implementation.


Example 4: Do staff have the skills and support to undertake remote physiotherapy delivery?

  • Data examples: Staff feedback forms, audit of training in digital platforms and communications skills.

  • Some considerations: Remote physiotherapy delivery requires enhanced communication and assessment skills, in addition to familiarity and expertise in using the appropriate digital platforms. The physical environment also needs to be considered, such as access to a quiet and private room space.


Example 5: What are the costs of providing remote physiotherapy delivery?

  • Data examples: Routinely collected data can be used to assess the relative costs or savings of remote physiotherapy delivery options. For example, how many digital contacts fail either due to technological problems or no-shows/lack of response from the patient? How much non-contact time does each practitioner have? How many patients are managed entirely remotely and how many convert to in-person contact?

  • Some considerations: It is often assumed that remote physiotherapy delivery options are cheaper but research shows that costs are either rarely described or that digital interventions are not cost-saving [2,3].


What should I do next?

  • Decide which aspects of your remote physiotherapy delivery you want to evaluate.
  • Think about the purpose? For example, to inform change in service design, or to inform a business case.
  • Look at previous evaluations for ideas of appropriate methods and measures. See the CSP's innovations database.
  • Consider what information you will need to answer your evaluation question. Are you already collecting this information?
  • Consider the demographics of your patient population and the accessibility of your service for all patients.
  • Only start collecting more information if it is needed to answer your evaluation question.

References

  1. The Health Foundation. Evaluation: what to consider. 2015
  2. Greenhalgh T, Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, Hanson P, Campbell-Richards D, Ramoutar S, Collard A, Hodkinson I. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res 2018;20(4):e150 DOI: 10.2196/jmir.9897
  3. Hollinghurst S, Coast J, Busby J, et al. A pragmatic randomised controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation. BMJ Open 2013;3:e003406. DOI: 10.1136/bmjopen-2013-003406
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