Are the goals of the virtual exercise classes for musculoskeletal (MSK) conditions being met? A service evaluation
DOI:
https://doi.org/10.59210/s2bf5r55Keywords:
F2F, MSK-HQ, telerehabilitation, virtual classes, service evaluationAbstract
Background: The COVID-19 pandemic prompted a shift to virtual physiotherapy services in the UK, aiming for cost-effective and safe rehabilitation. This evaluation focused on the efficiency of virtual classes for managing non-urgent lower limb conditions amidst the gradual return of face-to-face (F2F) classes. As pandemic guidelines evolved, F2F exercise classes were re-integrated along with virtual exercise classes. At this time, virtual classes were thought to be essential to maintain patient treatment, but the service has not been evaluated concerning efficiency and (potential barriers affecting) patient uptake, also in light of the diverse community St. Mary’s Hospital - Imperial College serves.
Methods: Forty-nine patient records were reviewed, assessing attendance, discharge rates, and outcomes. Virtual classes demonstrated good patient adherence (77%) and facilitated patient discharge (61%), reducing clinician time. However, missing data limited the assessment's comprehensiveness, notably regarding safety, barriers affecting class uptake, adverse events, and primary outcome measures like the Musculoskeletal Health Questionnaire (MSK-HQ; 98% missing).
Results: The findings support the efficacy of virtual classes but highlight the need for more rigorous data collection and documentation standards to ensure a comprehensive evaluation. Key recommendations include improving clinician documentation, tracking patient-specific benefits, and conducting audits for clinical oversight. These actions are crucial for maintaining physiotherapy standards and enhancing the effectiveness of virtual exercise classes.
Conclusion: Virtual classes demonstrate potential for managing lower limb conditions, showing good adherence and facilitating patient discharge. However, missing data underscores the importance of robust data collection and documentation. Future evaluations should focus on improving documentation standards and conducting audits for clinical oversight, essential for maintaining physiotherapy standards and optimising virtual exercise class outcomes.
References
1. Department of Health. Covid Emergency Response. 2021.
2. Zampolini M, Ilsbroukx S, Macellari V. Tele-rehabilitation: Present and future Towards cancer rehabilitation at home (Alpe d’Huzes project ACARE2Move) [Internet]. 2008 [cited 2024 Oct 11]. Available from: https://www.researchgate.net/publication/51431502.
3. Peretti A, Peters A, Tontodonati M. Telerehabilitation: Review of the state-of-the-art and areas of application. JMIR Rehabilitation and Assistive Technologies. 2017;4(1). doi:10.2196/rehab.7511.
4. Salisbury C, Ridd M, Stock C. Effectiveness of physiodirect telephone assessment and advice services for patients with musculoskeletal problems: Pragmatic randomised controlled trial. BMJ. 2013;346. doi:10.1136/bmj.f43.
5. Kobayashi D, Otsubo T, Imanaka Y. The effect of centralization of health care services on travel time and its equality. Health Policy. 2015;119(3):298–306. doi:10.1016/j.healthpol.2014.11.008.
6. Alexander M. Telerehabilitation: Principles and Practice. 1st ed. Elsevier; 2021.
7. Fatehi F, Wootton R. Telemedicine, telehealth or e-health? A bibliometric analysis of the trends in the use of these terms. J Telemed Telecare. 2012;18(8):460–464. doi:10.1258/jtt.2012.gth108.
8. Roy J, Levy DR, Senathirajah Y. Defining Telehealth for Research, Implementation, and Equity. J Med Internet Res. 2022;24(4). doi:10.2196/35037.
9. Brennan D, et al. A Blueprint for Telerehabilitation Guidelines. Int J Telerehabil. 2010;2(1):31–34. doi:10.5195/ijt.2010.6063.
10. Baroni MP, et al. The state of the art in telerehabilitation for musculoskeletal conditions. Arch Physiother. 2023;13(1):1. doi:10.1186/s40945-022-00155-0.
11. Khan F, et al. Telerehabilitation for persons with neurological disorders: A systematic review. Telemed J E Health. 2015;21(12):1009–1020. doi:10.1089/tmj.2015.0007.
12. Laver KE, et al. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020;2020(1). doi:10.1002/14651858.CD010255.pub3.
13. Wang X, et al. Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: A systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):173. doi:10.1186/s12891-019-2900-x.
14. Fonseca Dias J, et al. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med. 2021;55:155–162. doi:10.1136/bjsports-2019-101375.
15. van Egmond MA, et al. Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis. Physiotherapy. 2018;104(3):277–298. doi:10.1016/j.physio.2018.04.004.
16. Heiskanen T, et al. Uptake of Tele-Rehabilitation in Finland amongst Rehabilitation Professionals during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(8):1. doi:10.3390/ijerph18084383.
17. Morris J, et al. Clinician perspectives on mRehab interventions and technologies for people with disabilities in the United States: A national survey. Int J Environ Res Public Health. 2019;16(21):421220. doi:10.3390/ijerph16214220.
18. Aderonmu JA. Emerging challenges in meeting physiotherapy needs during COVID-19 through telerehabilitation. Bull Fac Phys Ther. 2020;25(1):1–8. doi:10.1186/s43161-020-00018-4.
19. Wang Q, et al. The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: A systematic review and meta-analysis of randomised controlled trials. J Telemed Telecare. 2021;27(1):3-12. doi:10.1177/1357633X20980291.
20. Jiang S, et al. The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. J Telemed Telecare. 2018;24(4):257–262. doi:10.1177/1357633X16686748.
21. Booij MJ, et al. Limited knee extension during gait after total knee arthroplasty is related to a low Oxford Knee Score. Knee. 2021;33:176–184. doi:10.1016/j.knee.2021.08.025.
22. Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015;24(12):2660-8. doi:10.1016/j.jstrokecerebrovasdis.2015.09.014.
23. Seron P, et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021;101(1):1–8. doi:10.1093/ptj/pzab053.
24. Bennell KL, et al. Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: a mixed-methods study. J Physiother. 2021;67(3):201–209. doi:10.1016/j.jphys.2021.06.009.
25. Bjorbækmo WS, Mengshoel AM. "A touch of physiotherapy" - the significance and meaning of touch in the practice of physiotherapy. Physiother Theory Pract. 2016;32(1):10-9. doi:10.3109/09593985.2015.1071449. Epub 2016 Jan 11. PMID: 26752250.
26. Malliaras P, et al. It’s not hands-on therapy so it’s very limited”: Telehealth use and views among allied health clinicians during the coronavirus pandemic. Musculoskelet Sci Pract. 2021;52:102340. doi:10.1016/j.msksp.2021.102340.
27. Graham SA, et al. Older Adults Engage with Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults. Front Digit Health. 2021;3:642818. doi:10.3389/FDGTH.2021.642818.
28. Twycross A, Shorten A. Service evaluation, audit and research: What is the difference? Evidence-Based Nursing. BMJ Publishing Group. 2014;17(2):65–66. doi:10.1136/eb-2014-101871.
29. Bevan H, et al. Improvement Leaders’ Guide Evaluating improvement General improvement skills. Coventry: NHS Institute; 2005.
30. Moule P, et al. Evaluation and its importance for nursing practice. Nurs Stand. 2017;31(35):55–63. doi:10.7748/ns.2017.e10782.
31. Martinez B, et al. Effectiveness of resistance circuit-based training for maximum oxygen uptake and upper-body one-repetition maximum improvements: A systematic review and meta-analysis. Sports Med. 2017 Dec;47(12):2553-2568. doi:10.1007/s40279-017-0773-4. PMID: 28822112.
32. Suchomel TJ, et al. The importance of muscular strength: Training considerations. Sports Med. 2018;48(4):765–785. doi:10.1007/s40279-018-0862-z.
33. Ramos-Campo DJ, et al. Effects of resistance circuit-based training on body composition, strength, and cardiorespiratory fitness: A systematic review and meta-analysis. Biology. 2021;10(5):377. doi:10.3390/biology10050377.
34. Hill J, Kang H, Benedetto K. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2016;6(8). doi:10.1136/bmjopen-2016-012331.
35. Borg G. Borg’s perceived exertion and pain scales. 1st ed. Champaign (IL): Human Kinetics; 1998.
36. Hall JB, Woods ML, Luechtefeld JT. Pediatric physical therapy Telehealth and COVID-19: Factors, facilitators, and barriers influencing effectiveness—a survey study. Pediatr Phys Ther. 2021;33(3):112–8. doi:10.1097/pep.0000000000000800.
37. Buabbas AJ, et al. Telerehabilitation during the COVID-19 pandemic: Patients and physical therapists’ experiences. Med Princ Pract. 2022;31(2):156–64. doi:10.1159/000523775.
38. Algarni FS, et al. Tele-rehabilitation service from the patient’s perspective: A cross-sectional study. J Patient Exp. 2022;9:237437352211308. doi:10.1177/23743735221130820.
39. Jette DU, et al. Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications. Phys Ther. 2009;89(2):125–35. doi:10.2522/ptj.20080234.
40. Östhols S, Boström C, Rasmussen-Barr E. Clinical assessment and patient-reported outcome measures in low-back pain–a survey among primary health care physiotherapists. Disabil Rehabil. 2019;41(20):2459–67. doi:10.1080/09638288.2018.1467503.
41. Fernandes L.G., Saragiotto B.T. At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain. Pain. 2021;163(2) –e181. doi:10.1097/j.pain.0000000000002364.
42. Falter M.E., Scherrenberg M., Kindermans H. Development and internal validation of the Digital Health Readiness Questionnaire: Prospective Single-Center Survey study. JMIR. 2022;24(8). doi:10.2196/41615.
43. Stark A.L., Krayter S., Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: A scoping review. Digital Health. 2023;9. doi:10.1177/20552076231218841.
44. Passias P, Bono J. Total hip arthroplasty in the older population. Geriatrics & Aging. 2006;9(2):1–6. Available at: https://www.medscape.com/viewarticle/546103_4 (Accessed: 22 February 2023).
45. Bang H, et al. Total hip and total knee arthroplasties: trends and disparities revisited. Am J Orthop (Belle Mead NJ). 2010;39(9)
