DEVISING ALTERNATIVE MODELS OF CARE FOR PHYSIOTHERAPISTS TO ENSURE CONTINUOUS PATIENT CARE USING REMOTE PATIENT MANAGEMENT PLATFORMS

J.S.S. Jayalath¹, M.D.A.I. Karunaratne², D.C. Rajakulathunga³, S.N. Silva⁴

Background: The unexpected crisis situation created by Covid-19 pandemic disengaged patients from their physicians and therapists all over the world. The Impulse Rehabilitation centre located in Welisara (a Western Province suburban town), Sri Lanka, was no exception. Nevertheless, it was important to identify means to provide continuous care to its patient base throughout the pandemic period. This involves attending to as many patients as possible and meeting their rehabilitation needs as much as possible whilst avoiding physical contact. Being a developing country with limited resources, it is important to deliver the above-specified service using low-cost, easy-to-use technologies. This meant the majority of the standard recommended treatment regimens had to be changed, improvised, and re-designed to involve entirely home-based treatment methods that, at best, require only facilities available at any common household.

Purpose: The main purpose was to identify an alternative model of care where a set of prioritized disease conditions can be managed remotely using suitable combinations of home-based treatment methods and modalities that can be demonstrated and monitored using low-cost commonly available online audiovisual platforms.

Methods: The researchers conducted a focus group discussion with 4 senior physiotherapists from the Impulse Rehabilitation Centre, 2 external physiotherapists, and a medical doctor. The discussion was conducted using an online video conferencing platform. The discussion points were mainly the disease conditions to focus on as a rehabilitation clinic operating in a crisis time using remote care methods and different treatment methods and modalities that can be used for continuity of care. The discussion was recorded, transcribed, and then thematically analyzed.

Results: The main themes and examples were identified as follows. Firstly, certain diseases can be categorized and treated together as common groups (ex: all types of arthritic conditions, chronic pain management). Secondly, patients with different diseases requiring common exercises can be categorized together into common groups (ex: upper limb exercise group for patients with cervical spondylosis, peri arthritis shoulder, epicondylitis, etc.; back exercise group for patients with scoliosis, mechanical back pain, sciatica, etc.). Thirdly, replacing therapist-based treatments with home-based exercises (ex: soft tissue release techniques replaced by self-release techniques through readily available items at home, passive neurodynamic exercises replaced by active nerve gliding exercises). Lastly, equipment-based treatments can be innovatively prescribed using home-based alternative measures (ex: hot packs to replace IRR machines, water bottles to replace dumbbells, quads-chair replaced by knee extensions with self-made sandbags).

Conclusion(s): Novel patient care models can be devised to ensure continuous patient care during a physical isolation period of a global pandemic or during any other emergency. It is important to compromise the need for optimum care in order to ensure more patient numbers are covered, with a higher percentage of their rehabilitation needs being met.

Implications: The findings of this study imply the importance of continuing patient care during a global crisis and a restricted environment even with the use of compromised and substituted care models and methods.

Funding, acknowledgements: The study was funded by Impulse Rehabilitation Centre, which is affiliated under the International Institute of Health Sciences, Sri Lanka.

Keywords: Remote patient care, Models of rehabilitation, Home based rehabilitation

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: International Institute of Health Sciences Sri Lanka

Committee: BioInquirer Ethics Review Committee

Ethics number: ECR/2020/088