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Barnett R, Shakaib N, Ingram TA, Jones S, Sengupta R, Rouse PC. Rehabilitation interventions delivered via telehealth to support self-management of rheumatic and musculoskeletal diseases: A scoping review protocol. PLoS One 2024; 19:e0301668. [PMID: 38625966 PMCID: PMC11020871 DOI: 10.1371/journal.pone.0301668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Telerehabilitation is a term to describe rehabilitation services delivered via information and communication technology. Such services are an increasingly important component for the management of rheumatic and musculoskeletal diseases (RMDs). Telerehabilitation has the potential to expand the long-term self-management options for individuals with RMDs, improve symptoms, and relieve pressures on health care services. Yet, little is known about the variety of interventions implemented, and how they are being evaluated. Thus, this scoping review aims to identify and describe existing rehabilitation interventions delivered via telehealth for RMDs. Specifically, we aim to identify and summarize the key components of rehabilitation, the technology used, the level of health care professional interaction, and how the effectiveness of interventions is evaluated. METHODS We will conduct this review following the latest JBI scoping review methodology and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). The 'Population-Concept-Context (PCC)' framework will be used, whereby the 'Population' is RMDs (≥18 years); the 'Concept' is rehabilitation; and the 'Context' is telehealth. Developed in collaboration with a subject Librarian, refined PCC key terms will be utilized to search (from 2011-2021) three electronic databases (i.e., Embase, Scopus, Web of Science) for articles published in English. Search results will be exported to the citation management software (EndNote), duplicates removed, and eligibility criteria applied to title/abstract and full-text review. Relevant information pertaining to the PCC framework will be extracted. Data will be summarized qualitatively, and if appropriate, quantitatively via frequency counts of the components comprising the 'Concept' and 'Context' categories of the PCC framework. DISCUSSION Findings from the proposed scoping review will identify how telehealth is currently used in the delivery of rehabilitation interventions for RMDs. The findings will develop our understanding of such interventions and provide a platform from which to inform future research directions.
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Affiliation(s)
| | - Nuzhat Shakaib
- Department for Health, University of Bath, Bath, United Kingdom
| | | | - Simon Jones
- Department of Computer Science, University of Bath, Bath, United Kingdom
| | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Peter C. Rouse
- Department for Health, University of Bath, Bath, United Kingdom
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2
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Atkinson-Graham M, Brunton G, Cancelliere C, Corso M, de Zoete A, Rubinstein SM, Murnaghan K, Mior S. Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review. Digit Health 2024; 10:20552076241236573. [PMID: 38495858 PMCID: PMC10943750 DOI: 10.1177/20552076241236573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Background Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders. Objective We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders? Data sources A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included. Study methods Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings. Results We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders. Conclusion The five identified implications could be used to inform future research, policy, and strategy development.
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Affiliation(s)
- Melissa Atkinson-Graham
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto ON, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, and Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, and Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Melissa Corso
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Annemarie de Zoete
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kent Murnaghan
- Library Sciences, Canadian Memorial Chiropractic College, Toronto ON, Canada
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto ON, Canada
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3
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Moulaei K, Bahaadinbeigy K, Mashoof E, Dinari F. Design and development of a mobile-based self-care application for patients with depression and anxiety disorders. BMC Med Inform Decis Mak 2023; 23:199. [PMID: 37784042 PMCID: PMC10544565 DOI: 10.1186/s12911-023-02308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND AND AIM Depression and anxiety can cause social, behavioral, occupational, and functional impairments if not controlled and managed. Mobile-based self-care applications can play an essential and effective role in controlling and reducing the effects of anxiety disorders and depression. The aim of this study was to design and develop a mobile-based self-care application for patients with depression and anxiety disorders with the goal of enhancing their mental health and overall well-being. MATERIALS AND METHODS In this study we designed a mobile-based application for self -management of depression and anxiety disorders. In order to design this application, first the education- informational needs and capabilities were identified through a systematic review. Then, according to 20 patients with depression and anxiety, this education-informational needs and application capabilities were approved. In the next step, the application was designed. RESULTS In the first step, 80 education-information needs and capabilities were identified. Finally, in the second step, of 80 education- informational needs and capabilities, 68 needs and capabilities with a mean greater than and equal to 3.75 (75%) were considered in application design. Disease control and management, drug management, nutrition and diet management, recording clinical records, communicating with physicians and other patients, reminding appointments, how to improve lifestyle, quitting smoking and reducing alcohol consumption, educational content, sedation instructions, introducing health care centers for depression and anxiety treatment and recording activities, personal goals and habits in a diary were the most important features of this application. CONCLUSION The designed application can encourage patients with depression and stress to perform self-care processes and access necessary information without searching the Internet.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Mashoof
- Department of Health Information Technology, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Fatemeh Dinari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Maltby A, Underhill A, Woodbridge S. The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review. HAND THERAPY 2023; 28:89-102. [PMID: 37904901 PMCID: PMC10581535 DOI: 10.1177/17589983231191867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 11/01/2023]
Abstract
Introduction In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. Methods This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Results Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted 'hands-on' treatment, resource and training concerns and limiting patient factors. Conclusions This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.
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Affiliation(s)
- Amy Maltby
- School of Allied Health and Social Care, University of Derby, Derby, UK
- Hand Therapy Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ann Underhill
- School of Allied Health and Social Care, University of Derby, Derby, UK
| | - Sarah Woodbridge
- School of Allied Health and Social Care, University of Derby, Derby, UK
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Booth G, Zala S, Mitchell C, Zarnegar R, Lucas A, Gilbert AW. The patient acceptability of a remotely delivered pain management programme for people with persistent musculoskeletal pain: A qualitative evaluation. Br J Pain 2022; 16:581-592. [PMID: 36452127 PMCID: PMC9703243 DOI: 10.1177/20494637221106411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Introduction Remotely delivered pain management programmes have been offered in place of in-person programmes by many chronic pain services since the onset of the COVID-19 pandemic. There is a lack of evidence regarding the acceptability of these programmes. In this evaluation, we have explored patients' acceptability of a remotely delivered pain management programme for patients with persistent musculoskeletal pain. Methods Qualitative data were collected using focus groups with participants who had previously attended the remote pain management programme. Data were analysed using abductive analysis. Results Three focus groups were conducted with a total of 13 participants. The programmme was either entirely acceptable, had some acceptable components or was not acceptable to patients. Factors leading to the programme being acceptable include learning to manage pain from home, receiving high quality care from home, enhancing the potential of rehabilitation using technology, enabling attendance on a pain management programme from home, overcoming social distancing requirements of COVID-19 using technology, and virtual peer support. Factors leading to the programme not being acceptable include having an inappropriate home environment for virtual therapy, communication challenges with virtual therapy, technological issues and concerns regarding the quality of care. Conclusions There is a spectrum of acceptability with respect to the remote programme. The factors that influence this are dynamic, individual and situational. Hybrid programmes have the potential to enhance access to pain management programmes and improve patient experience and programme outcomes in the future.
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Affiliation(s)
- Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Population Health Research Institute, St George’s University of London, UK
| | - Sonia Zala
- School of Health and Social Care, London South Bank University, London, UK
| | - Chloe Mitchell
- Department of Clinical Health Psychology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Roxaneh Zarnegar
- Pain Clinic, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Andrew Lucas
- Department of Clinical Health Psychology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
- Department of Psychology, City University of London, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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Seuren LM, Shaw SE. Using Linguistic Ethnography to Study Video Consultations: A Call to Action and Future Research Agenda. QUALITATIVE HEALTH RESEARCH 2022; 32:800-813. [PMID: 35245150 PMCID: PMC9152594 DOI: 10.1177/10497323221077297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Video consultations are a rapidly growing service model, particularly in secondary care. Studies, mainly using trials and post-hoc surveys, have routinely documented that they can be a safe and effective means to deliver care at a distance. While video offers new opportunities to provide health services, it also constrains how patients and clinicians can interact, raising questions about feasibility, quality, and safety-questions that cannot be adequately addressed with prevailing methods and approaches. To support successful and appropriate implementation, use and spread of video consultations, we need to investigate how video changes the interaction. In this article, we use two worked examples to demonstrate how Linguistic Ethnography, a methodological approach combining ethnographic with linguistic analysis, enables a detailed understanding of how communication in video consultations works, providing an evidence base to support patients and clinicians with using this service model.
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Affiliation(s)
- Lucas M. Seuren
- Nuffield Department of Primary Care Health
Sciences, University of Oxford, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health
Sciences, University of Oxford, UK
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Neher M, Nygårdh A, Broström A, Lundgren J, Johansson P. Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study. J Med Internet Res 2022; 24:e28870. [PMID: 35089139 PMCID: PMC8838545 DOI: 10.2196/28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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Affiliation(s)
- Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annette Nygårdh
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Gilbert AW, Jones J, Stokes M, May CR. Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID-19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting. Health Expect 2022; 25:775-790. [PMID: 35014124 PMCID: PMC8957728 DOI: 10.1111/hex.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
AIM To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID-19. To understand how patient preferences are constructed and organized. METHODS Semi-structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged. RESULTS Fifty-five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process. CONCLUSIONS This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID-19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations. PATIENT AND PUBLIC CONTRIBUTION The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.,Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, North Thames, UK
| | - Jeremy Jones
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Applied Research Collaboration, Wessex, UK
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Gilbert AW, May CR, Brown H, Stokes M, Jones J. A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations. Arch Physiother 2021; 11:20. [PMID: 34488898 PMCID: PMC8419808 DOI: 10.1186/s40945-021-00115-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC. METHODS A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference. RESULTS Eight F2F and 5 VC participants were included. Shorter appointments were less 'worth' travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive. CONCLUSIONS This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration, North Thames, London, UK.
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hazel Brown
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, UCL, London, UK
| | - Maria Stokes
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, Wessex, UK
- Southampton NIHR Biomedical Research Centre, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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10
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Williams D, Booth G, Cohen H, Gilbert A, Lucas A, Mitchell C, Mittal G, Patel H, Peters T, Phillips M, Rudge W, Zarnegar R. Rapid design and implementation of a virtual pain management programme due to COVID-19: a quality improvement initiative. Br J Pain 2021; 16:191-202. [PMID: 35425594 PMCID: PMC8998524 DOI: 10.1177/20494637211039252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 pandemic interrupted the delivery of face-to-face pain services including pain management programmes in the United Kingdom with considerable negative impact on patients with chronic musculoskeletal pain. We aimed to develop and implement a remotely delivered pain management programme (PMP) using video-conferencing technology that contains all the core components of a full programme: the ‘virtual PMP’ (vPMP). By reporting on the process of this development, we endeavour to help address the paucity of literature on the development of remote pain management programmes. Methods: The vPMP was developed by an inter-disciplinary group of professionals as a quality improvement (QI) project. The Model for Improvement Framework was employed with patient involvement at the design phase and at subsequent improvements. Improvement was measured qualitatively with frequent and repeated qualitative data collection leading to programme change. Quantitative patient demographic comparisons were made with a patient cohort who had been on a face-to-face PMP pathway. Results: Sixty-one patients on the PMP waiting list were contacted and 43 met the criteria for the programme. Fourteen patients participated in three vPMP cycles. Patient involvement and comprehensive stakeholder consultation were essential to a robust design for the first vPMP. Continued involvement of patient partners during the QI process led to rapid resolution of implementation problems. The most prominent issues that needed action were technical challenges including training needs, participant access to physical and technological resources, participant fatigue and concerns about adequate communication and peer support. Conclusion: This report demonstrates how a remotely delivered PMP, fully in line with national guidance, was rapidly developed and implemented in a hospital setting for patients with chronic musculoskeletal pain. We also discuss the relevance of our findings to the issues of cost, patient experience, patient preferences and inequities of access in delivering telerehabilitation for chronic pain.
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Affiliation(s)
- Deborah Williams
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Gregory Booth
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Helen Cohen
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anthony Gilbert
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Andrew Lucas
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Chloe Mitchell
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Gayatri Mittal
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Hasina Patel
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Tamsin Peters
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Mia Phillips
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Rudge
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Roxaneh Zarnegar
- Physiotherapy Department, Royal National Orthopaedic Hospital, Stanmore, UK
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11
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Gilbert AW, Davies L, Doyle J, Patel S, Martin L, Jagpal D, Billany JCT, Bateson J. Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary. BMJ LEADER 2021. [DOI: 10.1136/leader-2020-000363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
COVID-19 changed the way we delivered care to our patients at our Hospital. Prior to the pandemic, no patient facing video clinics and only a small number of telephone clinics were held. In this paper, we share our experience of rapidly implementing virtual clinics (VCs) due to COVID-19. This commentary is based on focused discussions between hospital leaders and provides a reflective account and commentary on leadership lessons learnt from our experience of deploying VCs. We outline success factors (being able to capitalise on existing strategy, having time and space to establish VCs, using an agreed improvement framework, empowering a diverse and expert implementation team with a flat hierarchy, using efficient decision pathways, communication and staff willingness to change), technical challenges (patient capability and skills to use technology, patient connectivity and platform capacity) and considerations for the future (sustaining new ways of working, platform selection, integration, business continuity and commissioning considerations, barriers regarding capability and communication, effectiveness and clinical outcomes). Finally, we provide an overview of the leadership lessons from this project and identify key areas of focus for delivering successful change projects in future (the vision, allocation of resources, methodology selection and managing the skills gap).
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12
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Gilbert AW, Mentzakis E, May CR, Stokes M, Jones J. Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment. J Health Serv Res Policy 2021; 27:62-73. [PMID: 34337980 PMCID: PMC8772015 DOI: 10.1177/13558196211035427] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.
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Affiliation(s)
- Anthony W Gilbert
- Clinical Research Physiotherapist, Therapies Department, Royal National Orthopaedic Hospital, UK and PhD Student, School of Health Sciences, 7423University of Southampton, University of Southampton, UK
| | - Emmanouil Mentzakis
- Associate Professor in Economics, Economics Department, Faculty of Economic, Social and Political Sciences, University of Southampton, UK
| | - Carl R May
- Professor of Medical Sociology, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, Professor of Medical Sociology, NIHR Applied Research Collaboration, North Thames, UK
| | - Maria Stokes
- Professor of Musculoskeletal Rehabilitation, School of Health Sciences, University of Southampton, UK, Professor of Musculoskeletal Rehabilitation, Southampton NIHR Biomedical Research Centre, Southampton, UK and Professor of Musculoskeletal Rehabilitation, NIHR Applied Research Collaboration, Wessex, UK
| | - Jeremy Jones
- Principal Research Fellow in Health Economics, School of Health Sciences, 7423University of Southampton, University of Southampton, UK
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Gilbert AW, Jones J, Stokes M, May CR. Factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting: a qualitative study. BMJ Open 2021; 11:e041038. [PMID: 33632750 PMCID: PMC7908916 DOI: 10.1136/bmjopen-2020-041038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To identify, characterise and explain factors that influence patient preferences, from the perspective of patients and clinicians, for virtual consultations in an orthopaedic rehabilitation setting. DESIGN Qualitative study using semi-structured interviews and abductive analysis. SETTING A physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK. PARTICIPANTS Patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem. Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem. RESULTS Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation of care (the ways that patients understand and explain their clinical status, their treatment requirements and the care pathway), the expectations of care (influenced by a patients desire for contact, psychological status, previous care and perceived requirements), the demands on the patient (due to each patients respective social situation and the consequences of choice) and the capacity to allocate resources to care (these include financial, infrastructural, social and healthcare resources). CONCLUSION This study has identified key factors that appear to influence patient preference for virtual consultations in orthopaedic rehabilitation. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete. A series of questions, based on these factors, have been developed to support identification of preferences in a clinical setting.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, North Thames, UK
| | - Jeremy Jones
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, Wessex, UK
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers. Br J Gen Pract 2020; 71:e1-e9. [PMID: 33318086 DOI: 10.3399/bjgp.2020.0967] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Remote consulting was introduced quickly into UK general practice in March 2020 as an emergency response to COVID-19. In July 2020, 'remote-first' became long-term government policy. AIM To explore how this change was portrayed in national newspapers and how depictions changed over time. DESIGN AND SETTING Thematic analysis of newspaper articles referring to remote GP consultations from two time periods: 2 March-31 May 2020 (period 1) and 30 July-12 August 2020 (period 2). METHOD Articles were identified through, and extracted from, LexisNexis Academic UK. A coding system of themes and narrative devices was developed and applied to the data. The analysis was developed iteratively, amending the coding structure as new data were added. RESULTS Remote consulting was widely covered in newspapers. Articles in period 1 depicted it positively, equating digital change with progress and linking novel technological solutions with improved efficiency and safety (for example, infection control) in a service that was overdue for modernisation. Articles in period 2 questioned the persistence of a remote-first service now that the pandemic was waning, emphasising, for example, missed diagnoses, challenges to the therapeutic relationship, and digital inequalities. CONCLUSION As the first wave of the pandemic came and went, media depictions of remote consulting evolved from an 'efficiency and safety' narrative to a 'risks, inequalities, and lack of choice' narrative. To restore public trust in general practice, public communication should emphasise the wide menu of consulting options now available to patients and measures being taken to assure safety and avoid inequity.
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