Physiotherapy at a distance- the patients' experiences

Lisbeth Eriksson, RPT, Fil. Dr.The County Council of Norrbotten

2012-06-20

Content

• E-health project

• Clinical research

Effects and the patients’ experiences of physiotherapy

at a distance

• Possible reasons

• Conclusions and understanding

• Where we stand today• Questions

Physiotherapy at a distance

It all started 1998…

To see and heareach other at adistance

The County Council of Norrbotten

• Ca 30 sh.surgery/year

• 35 primary care center

Sunderby Sjukhus

Results

Clinical good results

Research Patients’ experiencesIndividual interviews

Distance group Control group

10 12

53 - 85 50 - 86

Shoulder joint replacement

Osteoarthrosis, rheumatoid arthritis

The patients experiences of two months pysiotherapy at a distance at home

Findings

• A different reinforced communication

• Pain-free exercising as an effective routine

• From a dependent patient to a strengthened person at home

• Closeness at a distance• Facilitated daily living• Continuous

physiotherapy chain

At home

Physio-therapy at the hospital

Outpatient physio-therapy

Theme Access to continuous specific physiotherapy at home is a

prerequisite for recovery

A different communication(What was the feeling of seeing your self at the image?)

” Well, a bit exiting actual…,I was a bit astonished, yes, it was little hard. Is that the way I look like?...okey … mm (laughs).”

2-3 days

From results

A reinforced communication

In the physiotherapists focus.In the centre of the physiotherapistsattention – spoke and exercising. Listening with close attention and no

interruption.Respect and regard.

”I was very careful at the beginning and was thinking… how is it feeling… is it starting to hurt...

I was a little afraid… to move the arm, but it started to go better and better after some time. I think it was this special training especially of shoulders... And it became a daily routine”

Pain-free exercising as an effective routine

Initially a dependent patient

” It is easy… to be depressed right after the surgery when you can´t move, but now I had something to look forward to, the whole time… You have to be a little self-centred the first time (after surgery)…”

Finally a strenghten person

”I have became an expert on my body!”.

Closeness at a distance

“She came home to me, yes, she came in to my house. The only thing she couldn´t do was to touch me…

But we could not drink coffee together (laughs).”

Facilitated daily living

“I can turn on the TV, and the pan on the stove to cook in the kitchen, and it does not matter. I go back there when the training is completed.”

Continuing at the outpatient physiotherapy

“I think it is fine to go there now where they have these training equipment.”

Possible reasons for the results

• An userfriendly technique• Increasing access to specific physiotherapy with a

shorter delay between discharge and continued treatment at home (D-gr 1-2d, C-gr 7-15d).

• Physiotherapy at a distances have effectively adapted to the individual patient's need. Greater need immediately after discharge, reduction to about 10 min follow-up with guidance and advice

• Increased comfort and less risk of newly operated patients with pain and discomfort. Higher rated degree of health related quality of life (sign)

Reasons…

• Faster and greater improvement; pain and functional ability and health related quality of life (pain and vitality, sign).

• Distance spanning; more treatment sessions

• The continuity without interruption

• A safe and available technique for persons with cronic diseases after a shoulder surgery.

• A safe and strenghten patient at home.• Access to frequent support, feedback,

continuity and reinforced communication.• Specific body knowledge and being at

home were aspects contributing to an enhanced recovery competence.

Conclusion

My understandingThe development of online, interactive and patient-centered physiotherapy focuses on

• Patient’s participation. More involved in their care

• Another way of working. Not using the hands • Pedagogic role, communication, empathy and

understanding of the patient.

Physiotherapy at a distance at Sunderby hospital, Luleå

Implemented for patients who have undergone a shoulder joint replacement.

Tested for patients with Parkinson disease.

Complement instead of replacing the physical meeting between patient and physiotherapist.

•

Tack för visad uppmärksamhet!

Thank you!

lisbeth.eriksson@nll.se