USING FACEBOOK™ AS A PLATFORM FOR REMOTE PATIENT CARE TO ADDRESS REHABILITATION NEEDS IN A RESOURCE-LIMITED ENVIRONMENT DURING A CRISIS

M.D.A.I. Karunaratne¹, D.C. Rajakulathunga², J.S.S. Jayalath³, S.N. Silva⁴

Background: Covid-19 pandemic affected service delivery of Impulse Rehabilitation Centre, operating approximately 12km away from Colombo, Sri Lanka. The sudden disruption of rehabilitation services, the legislative challenges of the quarantine law and new social distancing norms, the financial impact and hardships imposed by the pandemic to the clinic as well as the patients, made continuity of care even a bigger challenge. Therefore, the administration board of Impulse Rehabilitation Centre decided to use a mobile-based telehealth solution with a free or low-cost platform, as Sri Lanka has a high volume of smartphone usage with reasonably priced and paced internet connections.

Purpose: To determine a technology platform that can reach the majority of the clinic’s patients as well as address the majority of their rehabilitation needs with a minimal cost.

Methods: A Delphi technique was used among a panel of rehabilitation experts comprising in-house and external therapists and medical practitioners. Initial questions were mainly based on establishing a low-cost, rapidly-deployable, widely-reachable technology platform that required little or minimal training. Hence, a remote patient management system was designed using the social media platform Facebook™, as it is the most popular platform in Sri Lanka with almost 6.5 million users.

Results: The Designed operational model is described under the below topics. “Defining therapeutic relationship”; where clinic patients were contacted and invited to join the “Impulse” Facebook group. The group administrator was identified as the clinic administrator and the physiotherapists were introduced formally to the patients. “Establishing communication”, was mainly via direct two-way messaging, facilitated by Facebook™, using text, audio/video calls. A brief and feasible guideline was given on the lighting, sound quality, connectivity and other such technical aspects. The thread of messages acted as the ‘patient record’, which was manually copied to the usual patient notes. “Clinical assessment” was done mainly via direct communication input, videos from the patient and photographs sent in by the patient. “Patient education and advice” was done using the same means and also through patient education documents. “Monitoring and follow up” was done using similar verbal and keyed-in responses as well as photographs and videos sent in by the patient. “Group-based rehabilitation” was also facilitated via ‘Facebook™ groups’ option where the selected patients were enrolled into a new group with their session therapist, who communicated with the whole group and shared instructions to the group at the same time using the same material. Patients were also invited to join appropriate group therapy sessions via video conferencing. Some feedback from patients within the group was used to motivate the other patients.

Conclusion(s): The social media platform Facebook™ was able to simulate most of the clinical interactions and therapeutic relationships between the Physiotherapist and the patient. This was a very useful tool to recommence continuity of care as soon as possible, after the abrupt disruption of physical clinic functions in a pandemic situation.

Implications: The use of a free social media platform is an effective emergency solution when the digital transformation of patient care becomes an urgent priority in a crisis.

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

Keywords: Social-media for rehabilitation, Remote patient management, Facebook for Physiotherapy

Topic: Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: International Institute of Health Sciences, Sri Lanka

Committee: BioInquirer Ethics Review Committee

Ethics number: ECR/2020/087