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A University of Manchester evaluation of remote physiotherapy services used across the UK during the coronavirus pandemic has shown the mix of in-person and remote care was “safe and acceptable” for patients.

Commissioned by the Chartered Society of Physiotherapy (CSP), the study – ‘Understanding the opportunities and challenges of remote physiotherapy consultations and rehabilitation during the Covid-19 pandemic’ – argues that a blended approach will allow physiotherapists (PTs) to provide more personalised care.

Based on the study, the CSP recommends a mix of in-person and remote consultations, arguing they are best for future service delivery models.

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The lead researcher, Helen Hawley-Hague, said: “Our evaluation of remote physiotherapy during the pandemic provided a very mixed picture around the success of remote physiotherapy.

“There were both great advantages to delivering remotely such as increased access to physiotherapy for some patients and a reduction in travel, but equally great challenges in terms of adequate connectivity and access for others.

“Remote methods of delivering physiotherapy should be an important part of a health professional’s toolkit and should be utilised where it can enhance treatment based on a person-centred approach to decision making.”

The University of Manchester’s evaluation includes a literature review, national survey and in-depth interviews with 12 service leads across the UK.

The CSP commissioned the National Evaluation of Remote Physiotherapy Services in 2020 after all non-essential in-person physiotherapy stopped and moved to remote service delivery. It compared the benefits and challenges of in-person and remote physiotherapy to determine how physiotherapy services can be equitable and effective for patients while making the best use of resources.

Benefits of remote physiotherapy

Time and cost savings were key factors in making remote consultations attractive to patients, the report found. For example, it was sometimes more convenient for patients to have remote consultations in terms of travel and time away from work or other commitments.

Very high levels of satisfaction and positive experiences with remote consultations were reported by patients who were able to access them during the pandemic.

The report also suggested that some individuals may prefer remote consultations for times when they discuss sensitive issues, or when their symptoms are aggravated by travel and different environments.

Remote consultations were an effective tool for keeping both patients and staff safe from catching coronavirus or other infections, the study highlighted.

Drawbacks of remote physiotherapy

According to the study, solely delivering remote consultations should not be viewed as a ‘one size fits all’ or long-term solution. Some patients still expressed a preference for some in-person consultations if there was no risk of catching COVID.

Remote consultations can also be challenging for when a physical assessment is required, the study underlined. It further said that the mental health needs of some people present challenges for remote consultations.

Additionally, there was a perception from some respondents that remote delivery may not be suitable for some individuals with cognition, language, learning or sensory needs. The report also warned that patients’ home environments could potentially present hazards or risks of falling.

Accuracy of assessment and diagnosis may be compromised by not being able to undertake hands-on examination and/or reduced visual detail, the CSP further assessed.

Recommendations for physiotherapists on delivering remote and face-to-face physiotherapy

There was no evidence to show cost savings from the digital switch because none of the 1,620 survey respondents had gathered data comparing the cost of remote and in-person physiotherapy.

An understanding of a patient’s communication needs, resources and digital literacy – together with the nature of treatment – should determine whether they have a digital or on-site consultation.

The report concludes that people should be given the choice to receive physiotherapy in person, remotely or a combination of both. However, this must be based on shared decision making, taking into account a person’s needs, their communication needs, and their ability to access online healthcare, the CSP advises.

Based on the findings, the CSP does not recommend an ideal ratio of remote/in-person, instead saying that it should be based on the patient population, individual need and available local resources.

Rachel Newton, Head of Policy at the CSP, concluded: “Person-centred care means being responsive to patient needs – whether their preference is for remote or in-person consultations, or combination of the two.

“The CSP has long supported the expansion of patient choice with new digital options that can save people time and money, and for some people help make services easier to access. At the same time we recognise that for some people, in some situations, in-person services will be the best option.

“It is also critical to ensure that those without internet access or help to navigate online healthcare are not missing out on essential services.”

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