We have all seen movies
or read dystopian fiction which pits Will Smith or Domhall Gleeson
against a sinister robot and paints an apocalyptic picture. Despite
these scary predications, my experience of future technology
has (until now) pinnacled in a hoover-robot which scares the cat and
gets itself stuck in the bathroom!
But now, thanks to Simon
Whitehart who is the Telehealth Service Coordinator at the Royal
Brisbane Women’s and Children’s Hospital (RBWH) I have expanded my
understanding. The telehealth services at RBWH is helping patients,
staff and services and there are no Turing tests or household cleaning
devices in sight.
RBWH knew it had 2 main issues to contend with in getting patients to
improve access to
outpatient MSK physiotherapy treatment as a means of non-surgical
management of their MSK condition after an Orthopedic Physiotherapy
Screening Clinic appointment (AKA interface
or MSK/Ortho advanced practice service).
Problem 1: patients live
so far away they either wait until the problem is so bad they can no
longer cope before seeking specialist opinion or they do not attend or
decline physiotherapy management because of the
distances they would have to travel regularly to gain the benefit.
During the time I spent with the screening clinic in RBWH one patient
had traveled for 9 hours, including a flight and an overnight stay in
order to access the clinic. This can be a huge disincentive
to accessing care.
Problem 2: waiting lists
were long and getting longer in regional centres where these patients
were traveling from. It is difficult to staff rural or remote clinics
and therefore services can be sparse and waiting
“if that patient has no access to follow up and they might live in the
Queensland interior, 200k to their nearest hospital. Or their
local hospital has a two year waiting
list for chronic. You think, right, I’m going to have to refer you to
telehealth. To improve access we refer to telehealth”.
Michelle Cottrell has
done a fantastic series of publications which provide evidence for the
use of telehealth technology. Dr Cottrell and her team have found that
clinicians found Telehealth increasingly easy
to use and effective as time progressed after implementation and
patients were willing to access telehealth if it reduced the costs and
time required to attend in-person appointments. Even more innovatively,
Dr Cottrell looked at the agreement between in-person
and telehealth assessments of patients with chronic MSK conditions
accessing an orthopaedic triage/interface service and found substantial
agreement between the two methods of assessment when deciding on
management pathways. Incredibly there was near perfect
agreement for referral to allied health colleagues. Diagnostic
agreement was 83.3% and onward referral for investigations was in
agreement in 81% of cases. In terms of outcomes a systematic review
found telehealth rehab improved physical function and improved
pain scores comparatively to in-person rehab.
I sat in on a patient
telehealth rehabilitation session with Steven who is the telehealth
treatment physio at RWBH. We are sat in a small office with a computer
and a webcam attached to the top of the monitor.
On the screen we can see into the patients’ home and she is explaining
how her neck posture exercises have been helping her upper traps pain.
Steven asks the patient to demonstrate her exercises side on to the
camera so we can see her neck retraction exercise.
Steven can even take a picture or video
of her doing the exercise and either play it back or annotate on the
picture as a means of further coaching the exercise using a web-based
programme called neorehab.com. Steven feels patients engagement levels
are often higher when using telehealth rather than in-person rehab.
Simon also reports that results are similar or virtually the same as an
in clinic session.
“It allows for a really contextual experience”. Simon Whitehart