![[Physio Explained] Is telehealth as effective as in-person physio for knee OA? with Prof. Rana Hinman](https://cdn-images-3.listennotes.com/podcasts/physio-network/physio-explained-is-1J8wY4d2Bkt-wW5lfMgHSQJ.1400x1400.jpg "[Physio Explained] Is telehealth as effective as in-person physio for knee OA? with Prof. Rana Hinman")
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We found that video conferencing was obviously, you know, there's probably no surprise here, was way more convenient for patients, but it also led to higher attendance rates at the physiotherapy consults.
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And we found that patients were actually more satisfied with telehealth and that they adhered better to the strength program that the physio prescribed them.
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Can osteoarthritis rehabilitation really be delivered effectively through telehealth?
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And what actually makes remote physiotherapy work for patients?
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And where do clinicians most commonly get it wrong?
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And as healthcare continues to evolve, will osteoarthritis care move towards a hybrid model that blends in-person treatment with digital rehab?
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Today's guest is Rana Hinman, an academic physiotherapist and professor at the University of Melbourne.
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She is also a National Health and Medical Research Council Investigator Fellow based at the Centre for Health, Exercise and Sports Medicine.
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Rana's research focuses on clinical trials of non-drug, non-surgical treatment strategies for osteoarthritis, particularly exercise, rehab, and biomechanical interventions.
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A major focus of her work is understanding how to support behaviour change and long-term exercise adherence in people with chronic musculoskeletal conditions.
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Her research also explores implementation science and ways to increase access to care through telehealth and digital health strategies.
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In today's episode, we'll explore what the evidence says about telehealth for NEOA and what clinicians need to understand about delivering high-quality care remotely and where the future of osteoarthritis rehabilitation may be heading.
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You're going to love today's episode.
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I'm Sarah Yule, and this is Physio Explained.
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Well, Run, thank you so much for joining us today, and welcome to the podcast.
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Thanks for having me.
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So we'll dive straight into the topic around telehealth versus face-to-face.
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So you've done a lot of work comparing video-based physio to face-to-face care for knee OA.
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In simple terms, what surprised you or perhaps didn't surprise you about how telehealth stacked up?
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Yeah, it's a good question.
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And we did a clinic, a big clinical trial that compared telehealth to in-person or face-to-face care for people with knee OA.
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And I guess what I wasn't surprised about was that Talihealth can actually deliver similar pain and physical function outcomes from a program that sort of is based around exercise, physical activity, and education, as what you can say or get from an in-person program.
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In fact, that was our hypothesis with the trial.
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So I'm not surprised that the findings were, you know, borne out that way in the trial.
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I guess what did surprise me though was that in that trial, we actually found that video conferencing outperformed in-person care on a number of the secondary outcomes.
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So, for example, we found that video conferencing was superior for improving physical activity.
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I think this one will surprise a lot of physios for actually building therapeutic alliance, because a lot of physios actually think that you can't build as much rapport over telehealth.
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We found that video conferencing was obviously, you know, there's probably no surprise here, it was way more convenient for patients, but it also led to higher attendance rates at the physiotherapy consults.
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And we found that patients were actually more satisfied with telehealth and that they adhered better to the strength program that the physio prescribed them.
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So a whole bunch of outcomes that actually did better with video conferencing compared to the exact same program delivered in person in physio clinic rooms.
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It's surprising, isn't it?
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And I think it flies in the face of what a lot of clinicians often think about telehealth, and to maybe a certain extent, surprises patients as well, that data.
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And I think the other thing that really stood out is as, you know, as I said, you know, we know that telehealth's convenient.
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And so often people are doing their consults from their own home.
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But I think what we've really seen in our research is actually how much telehealth allows people to stay engaged with their physio and keep attending to consults.
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And we've had numerous people doing their consults from all over Australia on holidays, including in tents in outback Northern Territory on sailing boats off the coast of Queensland, and they're still dialing in and doing their video conferencing consults with the physio.
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And I think that helps to probably explain why we see attendance is higher with video conferencing compared to in-person.
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Yeah, absolutely.
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It sounds like a lot of those barriers are just removed.
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Absolutely, yeah.
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We've certainly shown in um our trial that distance traveled, time spent traveling to appointments is obviously eradicated with, you know, with telehealth compared to actually having to go to the physio, battle traffic, find a car park, catch public transport if you have to.
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And that translates to cost savings for patients as well, which can be really important for people who are particularly living in sort of more rural, regional, remote areas, and who often have to travel further to get to the physio.
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So we actually found cost savings with video conferencing and particularly more so for people in those non-metro areas.
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That's fantastic, exceptionally compelling.
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So I'm curious from your research, what actually makes telehealth work really well for people with ON?
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And where do you think us as clinicians we can move in a direction of making telehealth a really effective modality?
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I think there's probably a few elements to why telehealth can be powerful for people with OA.
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One thing that has surprised us from our qualitative research is how much people say it feels personalized.
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And people use comments, you know, that make statements and comments and quotes about the fact that it feels to them like the physio is coming to visit them in their home because they're in their home and the physio is on the other side of the screen.
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It's really quite powerful for patients when the physio can watch them doing their physical activities that are causing them problems or doing the exercises that the physio's prescribing for them in their own home and with their own equipment that they're going to be using, as opposed to in the clinic where there might be a nice convenient couch or a nice stable chair with arms that they don't have at home.
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And so the physio and the physios tell us this as well, that they're really able to help troubleshoot any problems with exercise programs when they're consulting via Tally Health.
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So I think there's that real element of personalization which helps to create buy-in with the patient.
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And maybe that's why we've seen greater adherence, for example, with the strengthening exercise programs like we've seen in our non-inferiority trial.
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I think the other thing that really stands out for me as well, and as I said, this has come through in a number of trials and different qualitative research, but I do think there's a more equal power dynamic between the physio and the patient in the telehealth environment.
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And it's driven by the fact that the clinician can't put their hands on the patient.
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They can't do something to the patient or fix them by doing a treatment or a passive therapy.
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And so I think the patient tends to come to the consult, actually expecting to be an active participant in the treatment and actually taking control and having a lot more, I guess, agency over what's going to happen with any discussions and any therapy that's prescribed.
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And so I think that also helps to buy into that sense of it's personal, it's empowering.
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And the physios tell us that they actually like it because with OA, we know that manual therapy is not a core recommended treatment for OA.
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And telehealth actually allows them to do the stuff that clinical guidelines recommend for OA.
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And that's exercise prescription and physical activity and education and self-management.
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And it really takes away those expectations from the patient that the physio is going to do something to them and fix them.
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And so going to your other question about what do physios, you know, need to do well, or conversely, where can they go wrong with telehealth?
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I think it's really when physios try and just do business as usual, like what they normally do in-person care and just try and do the same old, not the same old, but you know, go-to habits, go-to processes, and try and do that over telehealth.
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And it doesn't, some bits can work, but a lot can't.
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So you can't obviously, it's not as easy to demonstrate exercises.
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You can't put your hands on to guide a patient or correct an exercise technique as you would.
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And so I really think there's a lot more preparation and forward thinking and forward planning needed for telehealth to work successfully.
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So often, you know, in our research, we have a whole lot of resources that we'll give the patients ahead of time, you know, exercise booklets that might be emailed, either in paper copy or emailed digitally, instructions obviously for how to connect with telehealth, how to troubleshoot, how to set yourself up, you know, what chair to be sitting on, what to be wearing, all sorts of things like that.
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So that, you know, the patient is really equipped to be able to, you know, engage successfully and not waste a whole lot of time because of technological difficulties, you know, when once the call or the consult starts.
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It sounds like it's really highlighting that the role of structured programs, clear exercise progression, those behaviour change strategies, and perhaps our ability to set expectations so that telehealth isn't simply face-to-face minus hands-on.
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I agree.
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I agree totally.
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And I think it's really important that for telehealth to be successful, that there's key expectations, you know, expectations are sensible from the outset.
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So really, I think it's a really important aspect for any physio service or physio to make sure they're really clear about what telehealth can and can't do for a patient so that patients don't come in with, you know, misguided beliefs about what will happen or what they'll get out of it.
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And so that they also come in knowing that they're going to have to do something.
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You know, exercise is a big part of it.
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Taking self-management strategies and advice to and implementing them in your daily life is a big part for helping to manage symptoms when you're when you're living with a chronic disease like osteoarthritis.
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Absolutely.
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It's also nice to see evidence that really highlights sometimes, it's easy for that education to fall into the back seat of what we offer, but it really is at the front, isn't it?
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Absolutely.
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And particularly with chronic conditions like osteoarthritis.
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We know that people with OA have a whole bunch of misconceptions, false knowledge, false beliefs about OA and what can and can't be done for it, often thinking that they have to have surgery and surgery is the only solution.
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And so education, good quality education about OA and its prognosis and what are effective treatments and what aren't effective treatments is really important to help get people engaging with high value care.
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Definitely.
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So, in terms of it sounds like there are many patients that telehealth is fantastic for.
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What about the ones where face-to-face is still quite important?
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It's a good question and something that physios often we worry a lot about safety.
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We don't, you know, we don't want to harm our patients.
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And there are no hard and fast rules about which patients are suitable for telehealth or not.
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And so physios must always use their clinical judgment.
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And it should always be a shared decision process with the patient as well.
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There will be patients out there who will refuse to use telehealth or will be unable to.
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And I think another thing that's really important is that we shouldn't just be thinking of telehealth as an all or none modality.
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In many cases, a blended or a hybrid approach with a mixture of in-person and telehealth consults will work really well and be appropriate for lots of people.
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But in terms of who it might not be quite as good a fit for, and people might want to be thinking about maybe I need to do an in-person visit first, obviously, it's not going to be a good option for any patient who's going to need any type of manual therapy or physical treatment technique where hands-on's required, or perhaps even where you need to do a very detailed physical assessment, perhaps to fit or prescribe a gate aid or fit a device such as a knee brace, for example.
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Also, patients where perhaps the diagnosis is not known.
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And so in the musculoskeletal field, for example, you know, a lot of patients may be presented with an acute problem that is yet to be diagnosed.
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And often we need assessment tests that do require hands-on tests or procedures to help reach that diagnosis.
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So for those sorts of conditions, that might be a good example of where an in-person consult or assessment is needed first to get that diagnosis and get a management plan going.
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But then after that, telehealth consults may well be appropriate for seeing the patient through that episode of care.
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Now we also need to think about patients where telehealth might be a safety risk.
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And so the obvious ones there are older, frail people who might have a heightened falls risk and or people who are not independently mobile and might be really weak or unsteady, dependent on others for their for mobility outside the house or even inside the house.
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Those would all be, you know, red flags, not red flags, but flags to you that might make you think perhaps not telehealth, at least for the first session.
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Also, for people who might be a little bit unsteady but don't have a carer at home who can be another pair of hands-on during the consult.
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So often in telehealth, we will use make use of carers in the home to help ensure safety.
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So that's something else to think about, people who live alone and might not be safe, or people with lots of comorbidities, complex medical conditions where you think exercise in the home without someone nearby could pose a risk to them.
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We also did quite a bit of research looking at the uptake of tally health during the COVID pandemic.
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And in particular, we looked and worked with the NDIS to look at how it was received by people with more profound disabilities, mental health problems, cognitive dysfunction.
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And those are groups of people, including children, who might have rehab needs, where you might want to think again about maybe an in-person visit for the first time.
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Just because people with vision and hearing impairments operating the technology can be really challenging and hearing and seeing each other well over technology.
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But also with kids, they can be easily distracted with telehealth and can drift off task pretty quickly.
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And it does often require a much higher burden from the parent to be involved with the child over telehealth to help be that sort of therapy assistant, if you like, which can sometimes become a bit frustrating for parents.
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And obviously, anybody who doesn't have access to the required technology or doesn't feel like they have the confidence with technology or even the digital literacy, you know, you might want to think twice about whether telehealth is going to be suitable for them in the first instance or even in follow-up sessions.
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It really sounds like it's a great framing to have.
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It's not about telehealth physicist in person.
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It sounds like it's very much matching the model to the patient.
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Absolutely.
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Absolutely.
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And what does the research say on this topic of the hybrid model?
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What does the research say about that longer-term sustainability?
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We haven't done any research on hybrid models as yet.
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I guess the work that's starting to come out with hybrid models is more looking at stepped care approaches where you might use sort of low-tech digital options in the first instance to avoid any clinician involvement.
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So using things such as apps or websites, for example, and then stepping up for people who don't do as well and bringing the clinician in.
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But I do think with the way that tech is taking off in healthcare, you know, we're only starting to see the beginning of the role of AI and just what AI is making possible.
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So I think healthcare is increasingly going to become tech-centered and these hybrid approaches are just going to become, you know, standard practice.
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I think patients are going to will increasingly demand or expect telehealth services to be offered to them when they want to take them up.
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And hopefully we'll see physios offering more and more telehealth services in these blended sort of hybrid approaches.
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And I think with regards to sustainability, we've now got, you know, telehealth funding models.
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That used to be one of the biggest limiters before the pandemic.
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You know, there was no reimbursement processes through either private health insurance or, you know, Medicare for telehealth.
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That's changed now here in Australia.
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So that that was one of the major barriers, and that's been removed.
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I think the biggest barriers now are physios' willingness to actually engage and offer these services because physios remain and you know are often a bit skeptical.
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We're hands-on, hands-on practitioners, and our oftentimes a lot of our professional identity is tied around our hands.
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So physios really need to make sure they're offering these services because patients can't experience them and uptake them if they're not offered by physios in the first place.
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And our research has shown that one of the biggest markers of um overcoming skepticism from both patients and physios is actually giving it a go.
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So we've found that patients and physios who are initially skeptical of telehealth, once they give it a go and are pushed outside their comfort zone, they're actually really pleasantly surprised with how effective and safe it is and actually how much, you know, patients value it and see it as a real, really positive option for accessing physiotherapy care for them.
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Rana, I think that's an absolutely, those are some brilliant points in there.
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And you're absolutely right.
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I think your work challenges that professional ego in the best possible way and reminds us that the outcomes in the OA, obviously, him, John, exercise and education and behaviour change.
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And when it's done well, telehealth isn't a compromise model.
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It's actually a very much, it's a strong evidence-based extension of high-quality care.
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Absolutely.
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So thank you so much for sharing your wisdom today.
00:19:47.839 --> 00:19:57.519
And I think the the key things for the clinicians listening is to obviously not underestimate our communication skills and don't assume hands on equals better outcomes.
00:19:57.680 --> 00:20:05.279
And I think you've helped us think really carefully about how our service model hopefully expands access to care.
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So thank you for helping us rethink those things.
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Thanks for having me, Sarah.
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We found that video conferencing was obviously, you know, there's probably no surprise here, was way more convenient for patients, but it also led to higher attendance rates at the physiotherapy consults.
00:00:17.359 --> 00:00:25.199
And we found that patients were actually more satisfied with telehealth and that they adhered better to the strength program that the physio prescribed them.
00:00:26.559 --> 00:00:31.359
Can osteoarthritis rehabilitation really be delivered effectively through telehealth?
00:00:31.519 --> 00:00:34.799
And what actually makes remote physiotherapy work for patients?
00:00:34.960 --> 00:00:37.679
And where do clinicians most commonly get it wrong?
00:00:37.840 --> 00:00:46.719
And as healthcare continues to evolve, will osteoarthritis care move towards a hybrid model that blends in-person treatment with digital rehab?
00:00:46.880 --> 00:00:52.880
Today's guest is Rana Hinman, an academic physiotherapist and professor at the University of Melbourne.
00:00:53.119 --> 00:01:00.719
She is also a National Health and Medical Research Council Investigator Fellow based at the Centre for Health, Exercise and Sports Medicine.
00:01:00.960 --> 00:01:12.079
Rana's research focuses on clinical trials of non-drug, non-surgical treatment strategies for osteoarthritis, particularly exercise, rehab, and biomechanical interventions.
00:01:12.319 --> 00:01:21.519
A major focus of her work is understanding how to support behaviour change and long-term exercise adherence in people with chronic musculoskeletal conditions.
00:01:21.760 --> 00:01:29.120
Her research also explores implementation science and ways to increase access to care through telehealth and digital health strategies.
00:01:29.439 --> 00:01:42.640
In today's episode, we'll explore what the evidence says about telehealth for NEOA and what clinicians need to understand about delivering high-quality care remotely and where the future of osteoarthritis rehabilitation may be heading.
00:01:42.879 --> 00:01:44.560
You're going to love today's episode.
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I'm Sarah Yule, and this is Physio Explained.
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Well, Run, thank you so much for joining us today, and welcome to the podcast.
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Thanks for having me.
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So we'll dive straight into the topic around telehealth versus face-to-face.
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So you've done a lot of work comparing video-based physio to face-to-face care for knee OA.
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In simple terms, what surprised you or perhaps didn't surprise you about how telehealth stacked up?
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Yeah, it's a good question.
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And we did a clinic, a big clinical trial that compared telehealth to in-person or face-to-face care for people with knee OA.
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And I guess what I wasn't surprised about was that Talihealth can actually deliver similar pain and physical function outcomes from a program that sort of is based around exercise, physical activity, and education, as what you can say or get from an in-person program.
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In fact, that was our hypothesis with the trial.
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So I'm not surprised that the findings were, you know, borne out that way in the trial.
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I guess what did surprise me though was that in that trial, we actually found that video conferencing outperformed in-person care on a number of the secondary outcomes.
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So, for example, we found that video conferencing was superior for improving physical activity.
00:03:05.520 --> 00:03:15.280
I think this one will surprise a lot of physios for actually building therapeutic alliance, because a lot of physios actually think that you can't build as much rapport over telehealth.
00:03:15.599 --> 00:03:27.039
We found that video conferencing was obviously, you know, there's probably no surprise here, it was way more convenient for patients, but it also led to higher attendance rates at the physiotherapy consults.
00:03:27.280 --> 00:03:34.800
And we found that patients were actually more satisfied with telehealth and that they adhered better to the strength program that the physio prescribed them.
00:03:34.879 --> 00:03:44.879
So a whole bunch of outcomes that actually did better with video conferencing compared to the exact same program delivered in person in physio clinic rooms.
00:03:45.120 --> 00:03:46.240
It's surprising, isn't it?
00:03:46.319 --> 00:03:56.159
And I think it flies in the face of what a lot of clinicians often think about telehealth, and to maybe a certain extent, surprises patients as well, that data.
00:03:56.319 --> 00:04:02.479
And I think the other thing that really stood out is as, you know, as I said, you know, we know that telehealth's convenient.
00:04:02.560 --> 00:04:06.479
And so often people are doing their consults from their own home.
00:04:06.719 --> 00:04:16.480
But I think what we've really seen in our research is actually how much telehealth allows people to stay engaged with their physio and keep attending to consults.
00:04:16.639 --> 00:04:33.439
And we've had numerous people doing their consults from all over Australia on holidays, including in tents in outback Northern Territory on sailing boats off the coast of Queensland, and they're still dialing in and doing their video conferencing consults with the physio.
00:04:33.680 --> 00:04:40.319
And I think that helps to probably explain why we see attendance is higher with video conferencing compared to in-person.
00:04:40.720 --> 00:04:41.519
Yeah, absolutely.
00:04:41.600 --> 00:04:44.720
It sounds like a lot of those barriers are just removed.
00:04:45.360 --> 00:04:46.399
Absolutely, yeah.
00:04:46.560 --> 00:05:03.439
We've certainly shown in um our trial that distance traveled, time spent traveling to appointments is obviously eradicated with, you know, with telehealth compared to actually having to go to the physio, battle traffic, find a car park, catch public transport if you have to.
00:05:03.680 --> 00:05:18.480
And that translates to cost savings for patients as well, which can be really important for people who are particularly living in sort of more rural, regional, remote areas, and who often have to travel further to get to the physio.
00:05:18.800 --> 00:05:26.079
So we actually found cost savings with video conferencing and particularly more so for people in those non-metro areas.
00:05:26.399 --> 00:05:29.120
That's fantastic, exceptionally compelling.
00:05:29.199 --> 00:05:35.759
So I'm curious from your research, what actually makes telehealth work really well for people with ON?
00:05:36.000 --> 00:05:43.759
And where do you think us as clinicians we can move in a direction of making telehealth a really effective modality?
00:05:44.480 --> 00:05:50.879
I think there's probably a few elements to why telehealth can be powerful for people with OA.
00:05:51.120 --> 00:05:56.959
One thing that has surprised us from our qualitative research is how much people say it feels personalized.
00:05:57.199 --> 00:06:09.279
And people use comments, you know, that make statements and comments and quotes about the fact that it feels to them like the physio is coming to visit them in their home because they're in their home and the physio is on the other side of the screen.
00:06:09.439 --> 00:06:32.079
It's really quite powerful for patients when the physio can watch them doing their physical activities that are causing them problems or doing the exercises that the physio's prescribing for them in their own home and with their own equipment that they're going to be using, as opposed to in the clinic where there might be a nice convenient couch or a nice stable chair with arms that they don't have at home.
00:06:32.240 --> 00:06:41.920
And so the physio and the physios tell us this as well, that they're really able to help troubleshoot any problems with exercise programs when they're consulting via Tally Health.
00:06:42.160 --> 00:06:47.920
So I think there's that real element of personalization which helps to create buy-in with the patient.
00:06:48.000 --> 00:06:57.040
And maybe that's why we've seen greater adherence, for example, with the strengthening exercise programs like we've seen in our non-inferiority trial.
00:06:57.279 --> 00:07:12.639
I think the other thing that really stands out for me as well, and as I said, this has come through in a number of trials and different qualitative research, but I do think there's a more equal power dynamic between the physio and the patient in the telehealth environment.
00:07:12.800 --> 00:07:17.519
And it's driven by the fact that the clinician can't put their hands on the patient.
00:07:17.680 --> 00:07:24.560
They can't do something to the patient or fix them by doing a treatment or a passive therapy.
00:07:24.720 --> 00:07:43.279
And so I think the patient tends to come to the consult, actually expecting to be an active participant in the treatment and actually taking control and having a lot more, I guess, agency over what's going to happen with any discussions and any therapy that's prescribed.
00:07:43.360 --> 00:07:49.199
And so I think that also helps to buy into that sense of it's personal, it's empowering.
00:07:49.519 --> 00:07:59.439
And the physios tell us that they actually like it because with OA, we know that manual therapy is not a core recommended treatment for OA.
00:07:59.759 --> 00:08:05.920
And telehealth actually allows them to do the stuff that clinical guidelines recommend for OA.
00:08:06.079 --> 00:08:11.199
And that's exercise prescription and physical activity and education and self-management.
00:08:11.279 --> 00:08:18.399
And it really takes away those expectations from the patient that the physio is going to do something to them and fix them.
00:08:19.120 --> 00:08:27.680
And so going to your other question about what do physios, you know, need to do well, or conversely, where can they go wrong with telehealth?
00:08:27.920 --> 00:08:42.960
I think it's really when physios try and just do business as usual, like what they normally do in-person care and just try and do the same old, not the same old, but you know, go-to habits, go-to processes, and try and do that over telehealth.
00:08:43.120 --> 00:08:46.480
And it doesn't, some bits can work, but a lot can't.
00:08:46.559 --> 00:08:50.480
So you can't obviously, it's not as easy to demonstrate exercises.
00:08:50.639 --> 00:08:56.399
You can't put your hands on to guide a patient or correct an exercise technique as you would.
00:08:56.559 --> 00:09:05.519
And so I really think there's a lot more preparation and forward thinking and forward planning needed for telehealth to work successfully.
00:09:05.840 --> 00:09:29.120
So often, you know, in our research, we have a whole lot of resources that we'll give the patients ahead of time, you know, exercise booklets that might be emailed, either in paper copy or emailed digitally, instructions obviously for how to connect with telehealth, how to troubleshoot, how to set yourself up, you know, what chair to be sitting on, what to be wearing, all sorts of things like that.
00:09:29.200 --> 00:09:41.519
So that, you know, the patient is really equipped to be able to, you know, engage successfully and not waste a whole lot of time because of technological difficulties, you know, when once the call or the consult starts.
00:09:42.720 --> 00:09:45.279
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00:10:10.480 --> 00:10:27.039
It sounds like it's really highlighting that the role of structured programs, clear exercise progression, those behaviour change strategies, and perhaps our ability to set expectations so that telehealth isn't simply face-to-face minus hands-on.
00:10:27.600 --> 00:10:28.240
I agree.
00:10:28.399 --> 00:10:29.200
I agree totally.
00:10:29.279 --> 00:10:38.720
And I think it's really important that for telehealth to be successful, that there's key expectations, you know, expectations are sensible from the outset.
00:10:38.879 --> 00:10:55.200
So really, I think it's a really important aspect for any physio service or physio to make sure they're really clear about what telehealth can and can't do for a patient so that patients don't come in with, you know, misguided beliefs about what will happen or what they'll get out of it.
00:10:55.279 --> 00:10:58.799
And so that they also come in knowing that they're going to have to do something.
00:10:58.960 --> 00:11:01.039
You know, exercise is a big part of it.
00:11:01.200 --> 00:11:13.279
Taking self-management strategies and advice to and implementing them in your daily life is a big part for helping to manage symptoms when you're when you're living with a chronic disease like osteoarthritis.
00:11:14.080 --> 00:11:14.960
Absolutely.
00:11:15.200 --> 00:11:25.600
It's also nice to see evidence that really highlights sometimes, it's easy for that education to fall into the back seat of what we offer, but it really is at the front, isn't it?
00:11:26.000 --> 00:11:26.720
Absolutely.
00:11:26.879 --> 00:11:30.320
And particularly with chronic conditions like osteoarthritis.
00:11:30.399 --> 00:11:45.279
We know that people with OA have a whole bunch of misconceptions, false knowledge, false beliefs about OA and what can and can't be done for it, often thinking that they have to have surgery and surgery is the only solution.
00:11:45.440 --> 00:12:00.080
And so education, good quality education about OA and its prognosis and what are effective treatments and what aren't effective treatments is really important to help get people engaging with high value care.
00:12:00.480 --> 00:12:01.519
Definitely.
00:12:01.759 --> 00:12:08.000
So, in terms of it sounds like there are many patients that telehealth is fantastic for.
00:12:08.240 --> 00:12:11.440
What about the ones where face-to-face is still quite important?
00:12:11.840 --> 00:12:16.559
It's a good question and something that physios often we worry a lot about safety.
00:12:16.639 --> 00:12:19.600
We don't, you know, we don't want to harm our patients.
00:12:19.759 --> 00:12:25.279
And there are no hard and fast rules about which patients are suitable for telehealth or not.
00:12:25.440 --> 00:12:28.480
And so physios must always use their clinical judgment.
00:12:28.639 --> 00:12:32.960
And it should always be a shared decision process with the patient as well.
00:12:33.200 --> 00:12:38.799
There will be patients out there who will refuse to use telehealth or will be unable to.
00:12:39.039 --> 00:12:45.120
And I think another thing that's really important is that we shouldn't just be thinking of telehealth as an all or none modality.
00:12:45.360 --> 00:12:54.799
In many cases, a blended or a hybrid approach with a mixture of in-person and telehealth consults will work really well and be appropriate for lots of people.
00:12:55.120 --> 00:13:27.039
But in terms of who it might not be quite as good a fit for, and people might want to be thinking about maybe I need to do an in-person visit first, obviously, it's not going to be a good option for any patient who's going to need any type of manual therapy or physical treatment technique where hands-on's required, or perhaps even where you need to do a very detailed physical assessment, perhaps to fit or prescribe a gate aid or fit a device such as a knee brace, for example.
00:13:27.360 --> 00:13:31.840
Also, patients where perhaps the diagnosis is not known.
00:13:32.000 --> 00:13:40.080
And so in the musculoskeletal field, for example, you know, a lot of patients may be presented with an acute problem that is yet to be diagnosed.
00:13:40.159 --> 00:13:49.600
And often we need assessment tests that do require hands-on tests or procedures to help reach that diagnosis.
00:13:49.679 --> 00:14:00.879
So for those sorts of conditions, that might be a good example of where an in-person consult or assessment is needed first to get that diagnosis and get a management plan going.
00:14:01.039 --> 00:14:07.600
But then after that, telehealth consults may well be appropriate for seeing the patient through that episode of care.
00:14:07.840 --> 00:14:12.639
Now we also need to think about patients where telehealth might be a safety risk.
00:14:12.799 --> 00:14:29.759
And so the obvious ones there are older, frail people who might have a heightened falls risk and or people who are not independently mobile and might be really weak or unsteady, dependent on others for their for mobility outside the house or even inside the house.
00:14:29.919 --> 00:14:38.320
Those would all be, you know, red flags, not red flags, but flags to you that might make you think perhaps not telehealth, at least for the first session.
00:14:38.639 --> 00:14:47.120
Also, for people who might be a little bit unsteady but don't have a carer at home who can be another pair of hands-on during the consult.
00:14:47.279 --> 00:14:53.440
So often in telehealth, we will use make use of carers in the home to help ensure safety.
00:14:53.519 --> 00:15:08.399
So that's something else to think about, people who live alone and might not be safe, or people with lots of comorbidities, complex medical conditions where you think exercise in the home without someone nearby could pose a risk to them.
00:15:08.639 --> 00:15:14.720
We also did quite a bit of research looking at the uptake of tally health during the COVID pandemic.
00:15:14.799 --> 00:15:25.679
And in particular, we looked and worked with the NDIS to look at how it was received by people with more profound disabilities, mental health problems, cognitive dysfunction.
00:15:25.919 --> 00:15:38.240
And those are groups of people, including children, who might have rehab needs, where you might want to think again about maybe an in-person visit for the first time.
00:15:38.559 --> 00:15:49.600
Just because people with vision and hearing impairments operating the technology can be really challenging and hearing and seeing each other well over technology.
00:15:49.840 --> 00:15:56.320
But also with kids, they can be easily distracted with telehealth and can drift off task pretty quickly.
00:15:56.480 --> 00:16:11.279
And it does often require a much higher burden from the parent to be involved with the child over telehealth to help be that sort of therapy assistant, if you like, which can sometimes become a bit frustrating for parents.
00:16:11.600 --> 00:16:29.519
And obviously, anybody who doesn't have access to the required technology or doesn't feel like they have the confidence with technology or even the digital literacy, you know, you might want to think twice about whether telehealth is going to be suitable for them in the first instance or even in follow-up sessions.
00:16:29.840 --> 00:16:32.639
It really sounds like it's a great framing to have.
00:16:32.720 --> 00:16:35.039
It's not about telehealth physicist in person.
00:16:35.120 --> 00:16:38.320
It sounds like it's very much matching the model to the patient.
00:16:38.639 --> 00:16:39.360
Absolutely.
00:16:39.600 --> 00:16:40.399
Absolutely.
00:16:40.720 --> 00:16:44.399
And what does the research say on this topic of the hybrid model?
00:16:44.559 --> 00:16:47.679
What does the research say about that longer-term sustainability?
00:16:48.159 --> 00:16:52.000
We haven't done any research on hybrid models as yet.
00:16:52.320 --> 00:17:06.480
I guess the work that's starting to come out with hybrid models is more looking at stepped care approaches where you might use sort of low-tech digital options in the first instance to avoid any clinician involvement.
00:17:06.559 --> 00:17:14.559
So using things such as apps or websites, for example, and then stepping up for people who don't do as well and bringing the clinician in.
00:17:14.799 --> 00:17:26.160
But I do think with the way that tech is taking off in healthcare, you know, we're only starting to see the beginning of the role of AI and just what AI is making possible.
00:17:26.400 --> 00:17:35.359
So I think healthcare is increasingly going to become tech-centered and these hybrid approaches are just going to become, you know, standard practice.
00:17:35.440 --> 00:17:44.559
I think patients are going to will increasingly demand or expect telehealth services to be offered to them when they want to take them up.
00:17:44.799 --> 00:17:52.960
And hopefully we'll see physios offering more and more telehealth services in these blended sort of hybrid approaches.
00:17:53.119 --> 00:17:58.319
And I think with regards to sustainability, we've now got, you know, telehealth funding models.
00:17:58.720 --> 00:18:01.519
That used to be one of the biggest limiters before the pandemic.
00:18:01.599 --> 00:18:08.240
You know, there was no reimbursement processes through either private health insurance or, you know, Medicare for telehealth.
00:18:08.400 --> 00:18:10.079
That's changed now here in Australia.
00:18:10.160 --> 00:18:13.440
So that that was one of the major barriers, and that's been removed.
00:18:13.599 --> 00:18:24.640
I think the biggest barriers now are physios' willingness to actually engage and offer these services because physios remain and you know are often a bit skeptical.
00:18:24.720 --> 00:18:32.960
We're hands-on, hands-on practitioners, and our oftentimes a lot of our professional identity is tied around our hands.
00:18:33.039 --> 00:18:42.799
So physios really need to make sure they're offering these services because patients can't experience them and uptake them if they're not offered by physios in the first place.
00:18:42.960 --> 00:18:52.880
And our research has shown that one of the biggest markers of um overcoming skepticism from both patients and physios is actually giving it a go.
00:18:53.039 --> 00:19:14.559
So we've found that patients and physios who are initially skeptical of telehealth, once they give it a go and are pushed outside their comfort zone, they're actually really pleasantly surprised with how effective and safe it is and actually how much, you know, patients value it and see it as a real, really positive option for accessing physiotherapy care for them.
00:19:14.799 --> 00:19:18.480
Rana, I think that's an absolutely, those are some brilliant points in there.
00:19:18.640 --> 00:19:19.680
And you're absolutely right.
00:19:19.839 --> 00:19:31.839
I think your work challenges that professional ego in the best possible way and reminds us that the outcomes in the OA, obviously, him, John, exercise and education and behaviour change.
00:19:32.079 --> 00:19:36.319
And when it's done well, telehealth isn't a compromise model.
00:19:36.400 --> 00:19:41.200
It's actually a very much, it's a strong evidence-based extension of high-quality care.
00:19:42.319 --> 00:19:43.680
Absolutely.
00:19:44.000 --> 00:19:47.759
So thank you so much for sharing your wisdom today.
00:19:47.839 --> 00:19:57.519
And I think the the key things for the clinicians listening is to obviously not underestimate our communication skills and don't assume hands on equals better outcomes.
00:19:57.680 --> 00:20:05.279
And I think you've helped us think really carefully about how our service model hopefully expands access to care.
00:20:05.519 --> 00:20:08.240
So thank you for helping us rethink those things.
00:20:08.480 --> 00:20:10.160
Thanks for having me, Sarah.
