Videoconferencing: a framework for physiotherapists

 

A Delphi study was used to create an international core capability framework for physiotherapy via videoconferencing. Q&A with Luke Davies.

Many physiotherapists have moved to providing patient care via videoconferencing, partly in response to the pandemic but also as part of an overall trend towards healthcare embracing telehealth. Is this well accepted by patients and how do the clinical outcomes compare?

Growing evidence suggests that patients are accepting of telehealth.

A recent survey conducted by the APA on physiotherapist and patient experiences of videoconferencing and a report on National Disability Insurance Scheme participants receiving physiotherapy care both found that patients and clinicians had generally positive experiences, despite clinicians rapidly shifting to remote delivery with little training.

Most patients still like to receive in-person physiotherapy, so it is not going to replace this form of delivery.

However, a proportion of patients would choose telehealth delivery even after the pandemic ends.

Evidence shows that when compared to in-person physiotherapy, physiotherapy delivered via telehealth can achieve similar and, in some cases, greater improvements in clinical outcomes.

Examples include rehabilitation after surgery (such as cardiac, knee replacement, shoulder hemiarthroplasty and hip fracture surgery), pulmonary rehabilitation and treatment for certain musculoskeletal disorders, such as osteoarthritis.

Would you say the incorporation of videoconferencing by the profession has been fast or slow and why?

Evidence suggests that compared to other health professions, physiotherapy had a slower uptake of telehealth prior to the COVID-19 pandemic.

A number of factors may explain the slower adoption, including a lack of government and private telehealth funding; a lack of physiotherapist confidence, knowledge and skills in telehealth; and often a resistance to changing methods of practice.

As physiotherapists, we are in a unique position to provide high-quality care to patients via videoconferencing and it’s encouraging to see the technology becoming more widely integrated into clinical practice.

Why did you conduct your Delphi study?

The increased popularity of telehealth due to COVID-19 highlighted a need for physiotherapists to receive additional guidance and training so they can optimally adapt to new service delivery models such as videoconferencing.

Luke Davies developed a framework of capabilities to help physiotherapists deliver care via videoconferencing. 

A review of the literature made it clear that no specific frameworks existed to help physiotherapists gain the knowledge, confidence and abilities necessary to deliver care via videoconferencing.

Therefore, we decided it was important to develop such a framework that could be used in a range of clinical settings.

How was the Delphi process conducted and how was a representative panel formed?

The Delphi panel completed three rounds of online surveys.

Panellists were asked to rate the importance of each capability in the first round and to suggest additional capabilities that they thought were important but weren’t already included in the draft framework.

The second round recorded levels of agreement on both retained and new suggested capabilities.

The panel re-rated the capabilities from round two in the third round and those that remained formed the final framework.

As a research team, we decided that forming a steering group to oversee the project was critical to ensuring the study’s quality.

Physiotherapy clinicians, academics, a policy representative from the APA and a representative from an Australian private health insurer made up the steering group.

So the purpose was to establish the core capabilities that physiotherapists need in order to deliver quality care via videoconferencing. What areas did those capabilities cover?

The capabilities in the framework cover areas including compliance, patient privacy and confidentiality, patient safety, technology skills, telehealth delivery assessment and diagnosis, and care planning and management.

Apart from guiding care by individual clinical physiotherapists, how else will the framework of capabilities be useful for the profession?

A wide range of stakeholders, including education and training providers, health insurers and the wider community, can benefit from and use our framework.

Curricular guidelines and standards for providing care in a digital environment are currently lacking in entry-level and postgraduate education across a variety of healthcare professions.

As a result, our framework may be used to inform future physiotherapy curricula in the delivery of telehealth as well as to provide assessment strategies and learning outcomes to better prepare graduates in tertiary education settings and to upskill practising physiotherapists through continuing education courses.

The framework may also be used by the wider community to understand what standards they should expect from physiotherapists when receiving care delivered via videoconferencing.

>> Luke Davies is a musculoskeletal physiotherapist working in private practice and a PhD student at the University of Melbourne within the Centre for Health, Exercise and Sports Medicine and the Department of Physiotherapy.

 

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