Hi, my email is mitchellj@csp.org.uk and on Twitter @Janeomit are most people using attend anywhere? or other platforms I know that they are using Attend Anywhere in Cornwall but not sure about other areas I am private, I use my online notes system with new secure video package, its called write upp. Zoom or skype if patient consents. Euan McComiskie : More and more each week using Attend Anywhere but it's not the only show on the road! Lots also using Teams or Zoom. Each service should explore with their local IG and consider the local patient needs. Attend Anywhere is a simple platform that doesn't need downloads or special equipment to work well. That's what makes it so popular We use Attend Anywhere in Somerset. Lists of clinics on Musgrove and community provider websites Using Attend Anywhere in Torbay Is zoom secure for Nhs? also any cost? We are starting to use Accurx for video assessments. Attend Anywhere in Exeter, mid and East Devon We use Attend Anywhere in Wiltshire Health & Care. Is this also available to private practitioners or just NHS? We are using a platform called Visionable - I haven’t used it yet but its 50/50 like marmite on user friendly etc would be good if there was a national agreement on the software that trusts could use, using Attend Anywhere in Gloucester. I think Attend Anywhere has been commissioned by NHSE&I - but not certain We are using AccuRx in GP practice in Gloucester We're being lined up to use Visionable imminently but no experience yet Yes in Banes Swindon and Wiltshire we are using AccRx, Attend anywhere and Visionable in my GP practice we are also offering email enquiries for people that want advice only. it is working well and it is possible for people to send photos to show swelling, skin conditions etc That's interesting - a hybrid approach I think is the way forward what platform are Trusts using for group based work? Hannah where can we find all those stats etc please?? Very interesting! Euan McComiskie : Zoom had some unfair and actually incorrect bad press in the early days of lockdown. Like any other video conference software it can be safe providing the security protocols are followed. It is for each trust to decide which software to use weighing up security and cost. There will be cost to use of almost all VC solutions if used by an organisation. Microsoft Teams is being phased out across all NHS trusts unless they already have an alternative VC solution What was the evidence for the rehab of Telehealth vs. F2F? Sorry I missed that. You can have up to 4 on attend anywhere. But we haven't tried yet for groups tele or video consultations are welcomed by working people who struggle to take time off Attend anywhere can take groups of 5 Can we have a list of refs please. our trust is using attend anywhere advantage is clinics can be booked and data and governance all collated same process whether work in physio or secondary care clinics is it video call telehealth or voice only telephone consultations? Euan McComiskie : Keep your eyes on Frontline next month for more from Hannah! Excellent, thank you. Is there a link to that evidence please that can be posted after? how long are the telehealth consultations vs face to face? is there a difference Thanks Hannah, very useful to allow us all to move forward Euan McComiskie : Apologies all. MS Teams is being rolled out rather than phased out to all trusts! Multitasking not my strong point! Love the innovative and collaborative approach Melissa Euan McComiskie : This week the CSP commissioned evaluation of remote solutions through COVID to add to the current evidence gap. Manchester Uni will work with us over the next year with early results published towards the end of the summer. Cottrell, Galea, O’Leary, Hill, Russell (2016) Real time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: A systematic review and meta analysis, Clinical Rehabilitation, DOI10.1177/0269215516645148 Cottrell, Hill, O’Leary, Raymer, Russell (2017) Patients are willing to use telehealth for the multidisciplinary management of chronic musculoskeletal conditions; a cross sectional survey, Journal of Telemedicine and Telecare, DOI10.1177/135763X1776605 Cottrell, Hill, O’Leary, Raymer, Russell (2017) Service Provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study, Musculoskeletal Science and Practice 32: 7-16. Cottrell, Hill, O’Leary, Raymer, Russell (2018) Clinician’s perspective of a novel home based multidisciplinary telehealth service for patients with chronic spinal pain, International Journal of Telerehabilitation what platform has Melissa used? Neorehab was the platform they were using the one mentioned in NZ that allows you to record the patient has anyone worked with new band 5s and video conferencing. think it works well with experienced staff but concerned those new to the role may struggle so wondering whether we should delay rotating less experienced staff through opd Phew you had me worried there with the MS Team phase out comment :) Euan have you got any technical advice on glitches etc?? Has Melissa been able to charge her normal fees for video sessions and clients been happy with this? I'd agree may be safer to have more experienced clinicians doing video calls as need higher levels of confidence with clinical reasoning/questioning We are piloting B5 staff member video conferencing at Bath - for long term sheilders this is a way to ensure career progression in the short term - we are ensuring maximum support Has anyone used outcome measures virtually? If so how, thank you our B5's are only currently doing a very small category 3 face to face list and then just shadowing B6 telephone appointments for their own learning do you think it is essential that you have seen the person F2F before starting remote? Euan McComiskie : Glitches are inevitable but there were always glitches in F2F sessions or pen and paper systems so nothing new! Having backup is always a good idea if the gremlins get in to the systems. Having the patients phone number to hand is always good and them having yours. Working with your ICT teams is always important so make friends with them and they might be more willing to help! I think band 5 maybe more slick with video consultations, and I don’t think that senior staff are necessarily better (where we would expect them to be in face to face communication skills), its new for all! We have just had a newly qualified Band 5 start and they are doing more training with him especially around the subjective assessment prior to getting him assessing, however if there are any issues the patient would be booked in with a senior clinician. I've been using the Oxford hip and knee scores over phone consultations - helps to then direct the subjective assessment somewhat In case not seen Hi Trish - do you think it is essential that you have seen the person F2F before starting remote? I have found it useful to mail the health screening questionnaire and appropriate outcome measure to patients who I am seeing via online consultation and agree I can get develop a good subjective assessment. Euan McComiskie : Never assume age or experience correlates with IT ability! Conducting a virtual session is tricky but so is doing it F2F. Make sure you have all the usual mentoring, supervision and CPD structures in place to pick up any issues We are sending our outcome measure (MYCAW) by email. It does take longer and it does take extra time to set patients up and you end up emailing after the session too. @Euan good point - as long as supervision is in place (for all!) Never too old, too experienced or too important to learn! Agree, it takes longer and am also sending follow up email and ex plans. Its also quite exhausting? Just have to get used to it I suppose. where space is tight we have curtained cubicles with 4 metres between computers staff are wearing masks in line with the guidance but are finding it frustrating even with the masks with windows to ensure a good patient experience and clear communication. Are any PT's in an organisation that does this differently please? Euan McComiskie : Regular breaks are important. We need to practice what we preach about exercise and regular movement. Working virtually is no different. Also need breaks from virtual sessions for food, toilet and head space. Don't forget to look after number one! hi not concerned that they wouldn't be able to do the video conferencing, more concerned that without the f to f exposure would they get the full objective assessments and the handling skills - looking at more mentoring time with peers as a way to resolve this I think the thing some people are struggling with is having new patient appointments reduced from 45 mins to 30 mins with virtual and telephone appointments. how do we ensure we’re not widening the socioeconomic and health gap with the rapid transition to digital interventions? Euan McComiskie : Evidence from Trish Greenhalgh showed that virtual sessions take the same amount of time than F2F sessions. We can save on the travel time for us and patients but the sessions themselves should not be any different On the physiotalk on Monday a student reached out to me concerned about how to prioritise assessments for use on telehealth assessments so perhaps there is a concern among less experienced clinicians Melissa Domaille : In response to question about band 5s, I have found it really helpful to have experience to facilitate risk assessment and clinical decision making. sorry to clarify my point I am interested if others have risk assessed the situation differently to allow staff to not wear a mask at a screen where social distancing is maintained easily - obviously we would use private rooms but this is not possible as we work virtually on larger scales Euan, is there a reference for that evidence please? Melissa Domaille : I also send out a health assessment questionnaire in advance to new patients and have put together an information sheet to help patients prepare for their video physio assessment. Euan McComiskie : In Scotland they are working to introduce VC booths in rooms in GP practices or community centres through the Highlands and Islands where connectivity and access to smart devices can be limited. That can help to address some of the socio economic inequality in healthcare Euan McComiskie : No reference to hand for that Trish Greenhalgh study but I will try to dig it out Bernice our Trust have said that if we are in shared spaces/offices but can maintain 2 m distance we don't have to wear masks Jane Mitchell : This is a link to information leaflets for patients from the Oxford research team. They are easy to read and clear https://protect-eu.mimecast.com/s/3JNTCOY3EcQOYwfvcnjz?domain=phc.ox.ac.uk Chris - How do you go about objective ax, or do you focus on subjective hx may sound a really silly question Issues of language barriers have been overcome in the diabetes service in London by having a translator on the video conference but only on audio, providing direct translation and reducing costs of travel and time for interpreters. Has anyone had much experience of doing telephone ax with an interpretor as a 3 way phone call? Any advice would be appreciated - the two I did last week felt very difficult Hannah.Morley1 : In my FCP practice we do subjective and then do obj via phone or video byt explaining to pt what movements/tests you want them to do. Similar to Hannah - phone or video for objective, utilising other members of the family to help if needed Hannah.Morley1 : Our GPs suggested using tel interpretor but I havent used it yet the only time I have had to use an interpreter we asked for a member of the family to do it and that worked very well i have used phone translation , it was tricky but it did work Yes I’ve had a couple of family members help, which worked well. We used prestige to call into the phone call to provide interpreter services Has anyone experienced DNA to the teleconsultation? I haven't and would be interesting to see data vs "normal" appointments I do ask for a double appointment slot as doing an assessment with translator takes a lot longer & 20 minutes is not enough time I haven't Liam Edwards, and everyone has been on time. Hannah.Morley1 : we have had DNAs, think its mostly lack of understanding about what the appt is and when it is Had a couple of DNAs but far less than normal which can make a full clinic day exhausting we have had DNA, about similar rates to face to face I’ve found the obj ax virtually has some interesting and unexpected benefits: the client has to feel much more in their bodies themselves, and explain to me what they are experiencing, rather than just relying on me feeling and looking. A couple have commented on this as really helpful Yes, I think they look approx 45mins to do the the interpreter appts Yes, I have had several DNAs for phone consultations, probably more than for F2F, better for video consultations been using video consultation prior to CVD within rheumatology but DNA have definately reduced i have also had 'DNAs' but less than during normal f2f clinics Yes a couple of DNAs for telephone appts Yes we have had people not answering their phones or logging into the AA waiting room so we send them a letter to say they missed their appointment and to call if they want to book another I ve less DNA s certainly definitely interesting as to what we need to include in undergrad training/courses! I have been helping a band 5 BSW tomorrow have a B5 talking as part of the discussions she has trainined an will be starting soon Same with the patients too . i have been amazed by the determination of some patients to make the IT work where i would have given up ( and they where the over 70 s !) I think very sensible to have physios working out of a hub rather than lone working as a band 5.... is anyone considering taking students at any point? Apologies if this had been asked as I joined late. most patients really appreciate support and have been very positive about video calls or telephone consultations.....some in preference to group or face to face. so much learning goes on in the informal ‘chat’ in a dept Euan McComiskie : Great point Alfie. Patients have different levels of IT ability. Those who stereotypically we think won't manage often flourish. I regularly see older patients and those with different disabilities being way more technology enabled than some might expect Jane Mitchell : The report by Anthony Gilbert et al fed back that they found 'floor walkers' very helpful supporting all of the clinicians to use the technology when starting virtual clinics Hannah.Morley1 : That sounds really difficult Bernice. Community Paeds. we have to wear masks in common areas and if moving around, but if 2meters apart we can take the masks off Same here in Somerset I am working with a Band 5 in one of urgent care hubs and they have recently started telephone consultations. The main thing we have found is requiring extra time and also a debrief session at the end of the morning Risk assessed in our Trust That’s the same as our policy in our MSK department We are wearing facemasks but making calls we are in own rooms so can take off for calls hi we are lucky to have individual rooms primarily however for a larger room with more than 1 person I have had to individually risk assess and deem the room covid secure What is your desk set up in the cubicle? Not working on a plinth are you Bernice? In our Hospice, we have the same policy as Emily Ayres. Yes that’s the same as ours, over 2m back to back and side to side. Euan McComiskie : And of course important to wipe down all screens and headsets etc after use. And if possible the same people using the same screens/headsets although understand that's not always possible Jane Mitchell : In Treliske in Truro the Therapy department has been risk assessed as 'COVID secure' so staff do not need to wear masks when in the department but do have to maintain the social distance Hannah.Morley1 : In AccuRx you can text links to patients if they dont have email or tablet We have been thinking about having hubs where patients can attend to use the virtual equipment (like passport hubs) there will be a virtual inequality and we need to make sure we are meeting the needs of those areas of deprivation text does not work for a subjective or pbjective but it is a great medium to send exericses . it is not just if they have a device, it is data use too Hannah.Morley1 : have look at this research article...it may provide some support for building rapport over telehealth...Cottrell, Hill, O’Leary, Raymer, Russell (2017) Service Provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study, Musculoskeletal Science and Practice 32: 7-16. Jane Mitchell : May be issues of infection control if computers are having shared access so need to risk assess and clean between people can anyone recommend a good exercises prescribing platform they use to email to patients following assessments? Rehab My Patient seems quite good so far Chris Martey : We're trialling both RehabMyPatient and MSK Assist But you don't need internet or a special device, you just need a phone Rehab my patient is offering some great deals at the moment and also starting PROM and has telehealth. Physiotec also good. Janet.Schmitt : Thanks for the meeting. Really interesting points and learning. I think Rehab My Patient is offering a 3 month trial -I think its great! Hannah.Morley1 : I also looked at the adpation of healthcare systems after disasters for my fellowship and found that crises (such as pandemics) widen health inequalities. Thats without even considering the conversation about moving more to online. We have to be very mindful. Also on Rehab my Patient you can ask them to add docs you want to include in email and also add exercises you use that are not available Can anyone recommend good headsets? Bluetooth ideally. Yes, some patients do not have the technology, some I have spoken to don’t have a compute https://assets.publishing.service.gov.uk/media/5eb97d30d3bf7f5d364bfbb6/staying-covid-19-secure-accessible.pdf covid secure poster once a risk assessment has been done, this is how we have been able to open up a couple of rooms to work in without masks alongside our individual rooms Hannah.Morley1 : We are often opting for tel consult rather than video consult, mainly because of time limitations rather than lack of digital access but tel calls are great too Melissa Domaille : My AirPods have been amazing anyone delivering group sessions or rehab? thinking rehab or post critical care follow up? in Cornwall falls prevention classes based on later life training and led by PSI trained staff are due to start soon some Trusts allow use of Zoom for groups, but others use MS Teams .... we are about to embark on group for pain self Mx. I seem to have lost sound so will leave the meeting and re-join… Hi all, is anyone know good exercise software which is comparable with EMIS or can link with EMIS Thats a great question What MSK Questionnaires do you send out? Melissa Domaille : could you repeat the name of the outcome measure you have been using in the hospice please. Thanks MYCAW - Measure yourself concerns and wellbeing MSKHQ is a generic one looking into the different aspects of their life. Hi what would be the Ig implications with patients returning outcome measures and pre questionnaires We are doing group sessions for our palliative care patients. Melissa Domaille : Thanks very much, I haven’t come across that, it sounds like it might be useful for my caseload We're running outdoor group Pilates classes Euan McComiskie : Attend Anywhere can have up to 4 in video consults. MS Teams has a much bigger maximum but can result in issues with latency. Zoom can have up to 250 if working on a pro license like Mindy is right now! Euan McComiskie : Any group provision needs to be risk assessed for exactly those reasons Angie. An excellent poi Jane Mitchell : I take part in a yoga class by Zoom each week and it works really well. We are trying to set up MSK OA knee and Back/ lumbar stability via hopefully Zoom which is a better external video and audio platform than teams We are very new to this, but personally I think five is the max at the moment. did you know there is 'International Chronic Pain Virtual Summit 2020' happening as we speak. Hannah.Morley1 : Samantha Payne...Steph choose us over them :) Having to leave now - thank you everyone, very informative from all speakers, has helped with increasing my confidence in the virtual world Yes I was thinking so much has progressed in just 2- months so a review in another 2 months would be really interesting.