Virtual Clinics in Primary Care Community MSK Physiotherapy Grainne - - PowerPoint PPT Presentation

Virtual Clinics in Primary Care Community MSK Physiotherapy

Grainne Duffin, Senior Physiotherapist, CHO 6 Niamh Vickery, Senior Physiotherapist, CHO 6

Setting-up Video Consultations

Advance contact with client Initial contact by phone to advise of new way of working Subjective history taken during this call Despite many clients having concerns, most were willing to try it Verbal consent was obtained

Advice for the client

Use a laptop rather than a smartphone Test that they can access the platform in advance Use a quiet room with space and plenty

• f light

Have a family member present if needed Wear loose, comfortable clothing

Important considerations for the therapist

Complete training on Attend Anywhere and practice to ensure confidence Ensure availability of a room with sufficient space and good broadband Use a script to ensure a thorough assessment

• Remain engaged and maintain eye contact

as much as possible

• Allow sufficient time for the person to

answer questions as sometimes there can be an audio delay

• The client often needed help positioning

their screen correctly to ensure ROM etc could be seen properly

• Ongoing risk assessment to ensure safety
• f the client was never compromised

During the Call

• Positive feedback from clients that their physiotherapy has commenced
• Appointments still possible if family/therapist are restricting their

movements - vulnerable and cocooning clients were protected

• An excellent way of encouraging self management
• Platforms that sent a text link for the call were very easy for the user to

navigate

• Very effective in younger clients especially post fracture/soft tissue injury
• r for CSp/UL
• Older clients/family members/carers were happy to have an exercise

programme

• Easy to establish SMART goals on the platform

What Worked Well

Challenges That Arose

• Some still prefer to be seen in person
• Broadband connection was often an issue for both the therapist and

client

• Loss of hands-on assessment and some subtle visual information is lost
• Can be difficult to assess swelling, muscle bulk etc. especially when

picture quality is poor

• Some difficulty assessing those with lumbar spine issues
• Some follow up face-to-face needed
• Inability to complete many standardised assessments completely on

initial VH consultation in some clients

• Accurate ROM/strength measurements not possible – guesstimate only

Some Practical Tips

• Prepare the client for the video call and how to

set everything up so that time is not wasted during the call

• Patience is key especially with those who aren’t

confident with technology

• Ensure that a family member or carer is present if

you need to perform a balance assessment

• Be prepared that you may ultimately need to

schedule a face to face appointment – video consultations won’t work for everyone

• Make sure you demonstrate all exercises and get

the client to perform them on screen to ensure they are doing them correctly

Virtual Clinics in Primary Care Community MSK Physiotherapy

Grainne Duffin, Senior Physiotherapist, CHO 6 Niamh Vickery, Senior Physiotherapist, CHO 6

Virtual Clinics in Primary Care Paediatric Physiotherapy

Sophie Conroy, Senior Paediatric Physiotherapist, CHO 6 Thelma Caples, Paediatric Physiotherapist, CHO 4

Overview

• Provision of 1:1 assessment and treatment via digital platforms

(Attend Anywhere, Blue Eye, Salaso) in a primary care setting

• Implemented in response to cessation of services due to Covid 19

and now a key component in service delivery

• Facilitates 'eyes on’ contact with service users when clinic

appointments not feasible

• Conditions assessed: Talipes/Torticollis/Developmental Delay,

Lower limb normal variants, gross motor difficulties

Pre appointment considerations

• Digital literacy, hardware, connectivity issues
• Inclusion/exclusion criteria
• Consent/DNA policies
• Phone screening, digital screen and subjective assessment
• A phone review can be enough – parent reassurance
• Prepare the family: send information leaflet of what is expected
• Post or email appointment details - what works best?

During the appointment

• Be prepared for technical glitches – have a back up plan
• Take time to create bond with child and parent
• Clear instructions with use of dolls/props for teaching
• Appoint a‘zone’ for older children eg yoga mat in view of screen
• Gait, posture, motor planning and adaptive motor patterns can be observed
• Functional assessments and outcome measures such as AIMS can be utilised
• Finish session with clear recap, goals and plan

Outcomes

• Positive
• Very positive feedback from families
• Facilitates empowerment as parents are ‘coached’ and become the enablers
• Intervention with reduced risk for immunocompromised cohort
• Appointments still possible if family/therapist are restricting their movements
• Easy to establish SMART goals
• Negatives
• Some families will prefer to be seen in person
• Loss of hands on assessment and some subtle visual information
• Inability to complete many standardised assessments
• DNA/Child protection issues

• Bar

arriers

• Connectivity
• Digital literacy
• Patients prefer clinics
• Time to set up
• Limited admin support
• Enab

ablers

• Parents are tech savvy
• Use of props/dolls
• Clear instructions
• Clear expectations of session
• Additional pair of hands
• Family support worker

Virtual Group – Chronic Disease Self Management

Martina Nolan, Senior Physiotherapist, CHO 6

Pre Pan andemi emic c – wha hat t did id th this is group

• up

programme ramme lo look li like ?

“Living ing Well: : A Prog

• gramme

amme for r Adul ults ts with h Long-term erm Health h Conditions”

• Self management group programme for people who live with a chronic disease
• Evidence based. Slaintecare funded. Collaboration with Trinity College Dublin.
• Format: 6 sessions over 6 weeks, 2.5 hours per session
• 8 – 12 participants

Pre Pan andemi emic c – what at did id th this is group up programme ramme lo look

• k li

like ?

• 2 trained leaders
• Interactive programme – brainstorming/group problem solving/action

planning/small exercise component

• Aspiration: Virtual delivery of traditional face to face programme without

loss of fidelity

Pla latfo form m choic ice Cisco Webex (Meetings) Platform:

Why?

• HSE approved
• Large number of participants permitted
• Different modes of content delivery - share powerpoint presentations/whiteboard
• User friendly design

Pla latform

• rm choic

ice

• Different screen modes
• active speaker modes
• pin speaker onto main video panel (leader remains on main

video panel, irrespective of who else is speaking)

• Chat function (private and public conversations)

Learn arning ing to use se P Pla latfo form m (we

webex ex)

• Virtual workshop with other Living Well Leaders who are

already leading the programme virtually

• Cisco webex online resource

https://www.webex.com/webexremotehealth.html

• precorded webinars
• live demos with Q&A

Outcomes comes

• 6/52 virtual Living Well Programme completed 28/09/2020.

Participants:

• Pre and post programme qualitative and quantitative measures

being reviewed by Trinity College Dublin

• DNA rate - 2 participant DNA of total of 9 participants
• Informal feedback – issues not significantly related to digital literacy.

But self-selecting group.

Tip ips fo for Vir irtua tual l Gr Group up Work

• rk

To ensur ure smooth h tra rans nsitio ition n from group face to to face form rmat t to to virtua tual l deliv ivery

• Use ICT HSE (Ivanti Self-Service – e.g. download Webex app/productivity

tool)

• Set up practice Webex meetings and practice, practice with colleagues
• Have a “Week Zero” – prior to start of programme
• Ensure all participants join session 15 minutes prior to commencement of

session

Reca cap.. p..

• Decide on platform
• Use /log issues with ICT
• Practice on platform with colleagues prior to going live
• Online learning resources re navigating platform
• Week Zero
• All join session 15 minutes before session start

GO FOR IT!