In this case study, written by Saiba Ahuja, we explore the rollout of video consulting in physiotherapy services in Wales.
Saiba is a member of the TEC Cymru Young Representative Panel which is made up of young people from all across Wales. The group regularly meets with the TEC Cymru team to collaborate on projects.
As part of her role in the panel, Saiba has written a series of case studies on the NHS Wales Video Consulting Service.
Video consulting (VC) has been successfully rolled out and utilised within Physiotherapy services across Wales to ensure patients are able to remotely access care.
Physiotherapy services provide advice, support and help to restore movement and function for those affected by injury, illness or disabilities. The work undertaken to deliver physiotherapy via VC has allowed the service to continue during unprecedented times whilst involving the patient directly in their own care.
Appointments over VC for physiotherapy have served a range of purposes including rehabilitation for injuries such as fractures, muscle strength training for those with brain tumours, exercises for those with hypermobility and harness checks for children with hip dysplasia.
Clinician User Story; Benefits and Challenges
In February 2021, a Physiotherapist from Swansea Bay UHB successfully carried out a session for a patient with neck and hand pain using VC. The patient was profoundly deaf, and previously the clinician had communicated with them via telephone consultation, with the assistance of the patient’s partner, but they decided to convert to video for an ‘objective examination.’ The conversion to VC was extremely beneficial for the clinician as it allowed them to ‘see the patient’s joints’ but also that it was ‘easier to converse as the patient could lip read’, making the consultation easier.
Furthermore, the appointment prevented the need for a face-to-face (FTF) appointment, and the clinician expressed that the video call ‘assisted my clinical decision making and helped me decide on the most appropriate imaging’. Following the appointment, the clinician said they didn’t have a preference for FTF appointment in this instance.
The physiotherapist rated the VC quality as excellent, however they did face a few challenges with regards to device and internet issues. They explained that ‘on occasion it is difficult to the access the platform which can be frustrating when time is so limited.’ However, for this physiotherapist the benefits outweighed the challenges tremendously and they felt that VC reduced waiting times and the likelihood of a patient not attending, which both also benefit the NHS.
The clinician acknowledged that this style of appointment was beneficial for their time and the environment as this appointment saved 45 minutes of travel for the clinician.
Overall Clinician Response; Benefits and Challenges
This clinician’s experiences reiterate that of other Physiotherapists carrying out appointments over VC. Out of 200 of the most recent surveyed VC appointments carried out by physiotherapists from the 12th of March 2021 to the 9th of July 2021:
- 27% of clinicians rated their appointment as ‘Excellent’
- 30.5% as ‘Very Good’
- 19% rated the overall appointment as ‘Good.’
With one clinician expressing that it was ‘Really great to be able to go through exercises together and make improvements, by being able to see each other, and share screen.’
Meanwhile, 12.5% of clinicians rated their VC appointment as ‘Okay’ and 11% rated it as ‘Poor’, with one clinician explaining that ‘the quality of the video was poor so difficult to see’ but the clinician acknowledged that is still ‘gave the patient more confidence to do his exercise program independently.’ Other clinicians gave this rating due to ‘microphones not working’, ‘video stalling’ and being ‘unable to reconnect’ which emphasises that technical difficulties and infrastructure support remains a barrier to success in some situations.
Patient User Story; Benefits and Challenges
A female patient aged between 45- 64 used VC for a therapy and treatment appointment with a Physiotherapist where the Physiotherapist ‘suggested exercises.’ The patient noted they had an ‘immediate, positive reaction’ to the appointment and felt that they were ‘more able to cope with life’ as well as ‘more able to understand and cope with their illness’. Furthermore, the patient acknowledged that they were more able to ‘help themself’ and that the VC session also ‘increased confidence about their health.’ The patient rated the overall VC quality as ‘Excellent’ and reported that it prevented the need for a FTF appointment and that ‘as an initial consultation, this is by far a more convenient approach.’
Overall Patient Response; Benefits and Challenges
The positive experience above echoes that of other patients attending video consultations with physiotherapists. Out of 200 of these appointments surveyed from the 16th of June 2021 to the 9th of July 2021, a large majority of 108 patients who form 54% of this group declared their appointment was ‘Excellent’ with a further 30.5% expressing that the appointment was ‘Very Good’ with patients praising the ‘easy access and instructions’ as well as the ‘nice clear picture and sound.’
Patients expressed how VC was ‘much more convenient as it saves time’ and is ‘more accessible’ due to not having ‘the hassle of waiting rooms and travelling/ parking.’ In addition, physiotherapy patients expressed that ‘it was very helpful to have exercises demonstrated’, that it ‘gave confidence in having the Physiotherapist observing and correcting’ and that they felt ‘very comfortable carrying out movements at home without COVID worries.’
A further 10% of patients rated their video appointment with a Physiotherapist as ‘Good’, and 2.5% rated it as ‘Okay’. Only 3% of physiotherapy patients rated their experience as ‘Poor’ and reasons cited often had to do with the difficulty of showing the Physiotherapist their movements, with one patient highlighting the ‘difficulty in holding the iPad and doing exercises’ and ‘the field view of the cameras meant it wasn’t always easy to follow exercises.’
Other patients indicated that VC was limited as the Physiotherapist ‘could not test how much force (patient) can apply or tension in (their) body’ indicating that at times, the virtual nature of the consultation did not allow complete physical examination.
Overall, physiotherapy VC sessions have been hugely successful, with both clinicians and patients mainly expressing how beneficial using VC is for the service. One clinician expressed the benefit of being able to ‘visually assess person and make human connection by seeing each other’ whilst a patient shared how video helps as it can be ‘difficult to articulate sometimes so being able to gesture and point on video is important.’