DO UK PHYSIOTHERAPISTS HAVE SUFFICIENT GUIDELINES AND TRAINING TO PROVIDE TELEHEALTH PATIENT CONSULTATIONS?

E. Leone¹, N. Eddison^1,2, A. Healy¹, C. Royse³, N. Chockalingam¹

¹Staffordshire University, Centre for Biomechanics and Rehabilitation Technologies, Stoke-on-Trent, United Kingdom, ²Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom, ³Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom

Background: The COVID-19 pandemic caused a rapid shift to remote consultations in the United Kingdom (UK) National Health Services (NHS), with most physiotherapy services unprepared for telehealth implementation. Digital transformation is a key NHS priority, with digital care expected to go mainstream in the near future.

Purpose: To explore the UK NHS physiotherapy services’ organisational telehealth readiness, focusing on guidelines implementation and staff training. Understanding the organisational preparedness of physiotherapy services in the use of telehealth will serve as a basis for the development of guidelines and training programs required for sustainable, long-term telehealth implementation.

Methods: A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK physiotherapists and physiotherapy service managers (PSMs) between May and June 2021. Data were analysed using SPSS software. Descriptive statistics were computed for the two study groups (physiotherapists and PSM). All variables were presented as frequencies and corresponding percentages.

Results: 222 participants answered the survey (36 PSMs and 186 physiotherapists). Most services, in which telehealth was in place, had implemented telehealth guidelines (physiotherapists:79%; PSMs:89%), with most guidelines produced by individual NHS hospital trusts. Most physiotherapists reported that guidelines had ambiguous areas (56%), whereas there was uncertainty among PSMs on whether current guidelines had ambiguous areas (yes:45%). The largest percentage of both groups reported that there is ambiguity or lack of information in current guidelines on how physiotherapists are protected from litigation (physiotherapists:70%; PSMs:74%), how to conduct an assessment without physical contact (physiotherapists:50%; PSMs:63%) , how to deal with an emergency (physiotherapists:57%; PSMs:53%), and telehealth training requirements (physiotherapists:45%; PSMs:53%). Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients (range:52-87%), while how to conduct telehealth with certain population groups were least reported (range:13-34%). Both groups reported that staff training focused on telehealth software (physiotherapists:61%; PSMs:91%) and hardware (physiotherapists:46%; PSMs:71%). Many PSMs (38%) reported that physiotherapists had not received training on how to provide treatment remotely. For both physiotherapists (42%) and PSMs (44%), training is needed on how to deal with emergencies during telehealth consultations.

Conclusions: UK NHS physiotherapy services were not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities. Most guidelines are issued at a local level, highlighting the necessity of robust central guidelines. There is limited readiness of the clinical processes, which manifested as lack of training to provide treatment in a virtual environment and failure to tailor telehealth consultations to vulnerable population groups.

Implications: Future telehealth guidelines need to include advice and clear recommendations on how to conduct assessment without physical contact, training requirements and safety considerations to limit unintended risks to patients, avoid physiotherapists’ liability exposure and widening health inequalities. Digital inclusion approaches are needed in physiotherapy services to ensure that vulnerable population groups can benefit from digital technologies. Physiotherapists must be trained to respond to emergencies and to provide interventions remotely in order to safely and confidently practice in an increasingly digital world.

Funding acknowledgements: The project has been funded by Public Health England through the British Association of Prosthetists and Orthotists (BAPO) (reference: 6719098).

Keywords:
Telehealth
Guidelines
Training

Topics:
Globalisation: health systems, policies & strategies
Professional practice: other
Education: continuing professional development

Did this work require ethics approval? Yes

Institution: Staffordshire University

Committee: Staffordshire University Ethics Committee

Ethics number: SU20-153-RN