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As restrictions ease, how will physiotherapy work?

Nurturing

HOME CARE While physios can now see some clients face to face in their clinics, video consultations are common and working well.

Health
Andrew O'Brien

It’s the new normal, in these unprecedented, challenging times, to come together by staying apart and repeating the same half a dozen phrases until we’re blue in the face – preferably either in a remote or virtual setting. Thankfully, our fearless and occasionally shirtless leaders are confident they have things in hand, especially now that the daily statistics are going in the right direction and restrictions are easing.
The latest trend is roadmaps. So far the Government, the Department of Education and even the GAA have released roadmaps. One of my long-held gripes with corporate pseudo-speak is the habit of taking a word that works perfectly well and replacing it with one that sounds more complicated.
Normally, we would have a simple plan to ease restrictions, open schools or restart sport. Not anymore; in these challenging times we need a roadmap. I love a good map; I could happily spend an afternoon flicking through an atlas. Now, I’d happily use that same atlas to batter the head of the next spokesperson or newsreader who says roadmap.
What of physiotherapists? Do we have a – ahem – plan for working in the new normal? Funny you should ask; yes, we do.
From the outset, physios have been working to set up platforms for telehealth consultations. More jargon – telehealth is merely a fancy way of saying video. Instead of meeting face-to-face in a clinic, the consultation is done through any of the countless video-calling platforms that are available. Once you reach the stage where a therapist might normally try some form of ‘hands-on’ type treatment, we move directly to setting an exercise programme that gives patients the tools to help themselves.
Since the easing of restrictions, it has been possible for physiotherapists to open their doors and see some clients face-to-face, but still under quite strict guidelines. To begin with, the physio has to make a clinical judgement as to whether a person really needs to be seen face to face; at the later stages of a rehab programme, continuing by video makes perfect sense.
If a face-to-face appointment is the best option from a physio perspective, the health risks then need to be assessed. Do you have a temperature or a cough? Have you been in contact with anyone with Covid-19?
If you are deemed sufficiently low-risk, then a physical appointment can be made. Even then, the guidelines dictate that a consultation is not what it once was. As much as possible of the initial history taking and observation will still be done remotely. Then, once the actual consultation arrives, both you and the therapist will be wearing masks, and the physio a gown and maybe gloves.
For the majority of a consultation, the physio will stay outside of your two-metre space, observing and instructing, and will only come within two metres for any treatment that requires physical contact or to guide you through exercises for less than 15 minutes of the consultation time. In between, the physio has to clean down the room thoroughly before and after to make your regular appointment time a much bigger production than it was a few short months ago.
Does it work though, this new normal of telehealth? The blunt answer is yes. Perhaps the most important benefit for everyone is that of responsibility.
From a patient perspective, having to take responsibility for your rehab is key. Many of us rely on health professionals to ‘fix’ our problems. If nothing else, this period has reinforced the need to own your problems and do something about them. An hour-long consultation leaves you with 10,000 more minutes in the week; which do you think might have a bigger bearing on your recovery? Also, the embarrassment of not being able to remember your exercises at your follow-up video call should improve compliance!
As physios, working remotely forces us to work hard on our clinical reasoning to come up with exercises that are at the right level of difficulty and stimulating enough to keep the patient interested. It’s no easy feat, but there is no harm in being made to think differently sometimes.
Like so many other businesses, physiotherapy has seen other unexpected changes. I’ve had video consultations with people in the UK and Australia lately; something I never would have considered before. When things settle, they might need a roadmap to find the clinic. The rest of us should stick to the plan.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.