Introduction

People are living longer and the need for health care is rising.

One new way of providing health care is with the use of technology to provide physiotherapy treatment via the internet, and so save people from having to travel to hospital appointments. This will be especially useful where specialist services mean travelling considerable distances. Research has been carried out along these lines, to determine how technology can help patients get the care they need. This research showed that even though technology was found to be useful, it has not yet been incorporated very much in clinical practice.

Patients from all over the country attend the Royal National Orthopaedic Hospital (RNOH) at Stanmore, a national specialist centre for physiotherapy. They often find that the trip to get to the RNOH is a challenge. We have already looked at how technology can be used to help patients consult with their physiotherapist and occupational therapist. For the purposes of the study we have looked only at shoulder problems. Some patients chose to take up the option of using a video call and others did not. Patients who chose to use a video call found that this negated the need to travel and its use greatly improved their experience.

It is important to now look at what patients like and dislike about the use of technology. From this research we hope to design a new way for patients to use available technology for the purposes of physiotherapy treatment. This will support them in getting the help they need for their health problems. Our research aims to design, implement and evaluate a technology supported consultation process so as to enable access to care without the need for repeated hospital visits.

We will do this in four phases

01. Research

Review of Previously Published Research

What do we already know?

Read more

02. Interviews

Interviews with Patients and Hospital Staff

What do patients already know?

Read more

03. Patient Survey

Interviews with Patients and Hospital Staff

What are patient preferences?

Read more

04. Design

Design a New Way of Working Using Digital Technology

What do these preferences look like in clinical practice?

Read more

Next steps

Following the conclusion of Phase 4 we will survey both patients and hospital staff to evaluate their experience with the use of the proposed technology.

The results of the above detailed research will be presented in journals, at research meetings, on

the CONNECT Project website, and using social media such as Twitter & Instagram

We have set up a patient and public involvement group that will be actively involved in helping drive the research forwards at each research stage. The steering group consists of 10 members (made up of RNOH patients & members of the public), a technical author to support the plain english summaries, and two group co-chairs (a member of the public and an RNOH Physiotherapist.)

To our knowledge, no previous work has explored the role of patient choice and its role in the uptake of technology.

It is believed that knowledge of patient preference will help clinicians, researchers and policy makers to better understand how to lead the introduction of technology supported appointments. This project will focus specifically on orthopaedic physiotherapy appointments, but it will assist in supporting the take-up of technology in other areas of the NHS. This will provide a better patient service and reduce costs to the NHS and patients.

Project plan

The research is split into four phases:

Phase 01

Effectiveness of Communication Technology (months 1-6)

Research Question: What is the effect of Communication Technology on patient workload?

We will complete a systematic literature review of all the qualitative studies reporting patient access to their clinicians using communication technology. The protocol of the systematic review will be registered on the International Prospective Register for Systematic Reviews database (PROSPERO). We will organise all of the qualitative data into the components of Normalisation Process Theory, and will then develop a taxonomy of the workload for a patient using these technologies.

Factors identified in Phase 1 will be used to inform semi structured interviews in Phase 2.

Phase 02

Burden of Treatment (months 7-12)

Research Question: How does the change in workload impact on the burden of treatment?

We will interview 20 patients who are attending outpatient physiotherapy at the RNOH and 20 physiotherapists. We will explore how this change in workload for patients would affect the experience of receiving specialist physiotherapy. In addition to this we will discuss the various options for communication technology supported healthcare so as to support the design of the Discrete Choice Experiment (DCE) in Phase 3.

Results from the qualitative interviews in Phase 2 will be used to design the attributes and levels of the DCE in Phase 3. Participants will be asked to prioritise these.

Info SheetParticipant InfoTherapist InfoPatient Info

Phase 03

Care in Orthopaedics (months 13-21)

Research Question: What are patient preferences for the use of Skype for their Care in Orthopaedics?

We will conduct a Discrete Choice Experiment (DCE) that will collect demographic data and patient preferences for different scenarios incorporating Skype consultations. Patients attending specialist physiotherapy will be asked to complete the DCE on a tablet computer. We will then conduct a logistic regression to establish the weight of these preferences. A sample size calculation will be conducted following the pilot of the DCE. It is expected that 250-300 patients will be required.

Results from Phase 3 will inform the design of the minimally disruptive consultation in Phase 4. Prior to the pilot in Phase 4 interviews will be conducted with both patients and clinical staff to assist with the design of the consultation.

Phase 04

The Connect Project (months 22-30)

Research Question: How can these preferences be incorporated into clinical practice? – a pilot of Modified Clinical Practice.

We will conduct focus groups consisting of patients and physiotherapists to support the design of a clinical pathway using Skype. We will pilot this pathway with 20 patients and clinicians and interview them afterwards to determine the acceptability of the pathway.

The final six months (months 30-36) of the research will be reserved as a contingency and
for preparation of manuscripts and the final PhD thesis.

Patient & Public Involvement Steering Group

The CONNECT Project Patient and Public Involvement (PPI) Steering Group is an important part of the overall project. The purpose of the group is to provide a patient perspective for the design and delivery of the research. The first group meeting was held in August 2016 (see picture) where Anthony Gilbert presented the initial outline for the research plan.

Minutes of all meetings will be recorded and published on the CONNECT Project website.

The Group

The CONNECT Project Patient and Public Involvement (PPI) Steering Group is an important part of the overall project. The purpose of the group is to provide a patient perspective for the design and delivery of the research. The first group meeting was held in August 2016 (see picture) where Anthony Gilbert presented the initial outline for the research plan.

Discussion

Discussions were had around the line of inquiry (accessing specialist hospitals) and agreement was made to focus on the difficulty or ease of access. It was agreed to concentrate on physiotherapy, as many aspects of the hands-on assessment are relevant in other areas of medicine. 

Clinical Area

In addition, keeping the project within just one clinical area makes the research logistically more simple. Another important point raised was that of access. Some patients might not have access to the technology required to contact their therapists via the internet. 

Outcome

As a result of this, 20 desktop computers will be purchased and couriered to the patients. These will be returned following the consultation.

The Role

The role of the PPI Steering Group is to discuss and refine the protocol and findings of each phase. The group will meet five times over the course of the research; at the start of each of the 4 phases, and on completion of the research.

Location

Meetings will be held at the Royal National Orthopaedic Hospital in Stanmore. Food and refreshments will be provided.

PPI Steering Group Members

There are a number of PPI group vacancies, please email anthony.gilbert@nhs.net if you would like more information about dates and joining the steering group.

Helen Harte

Co-Chair

Anju Jaggi

Consultant Physiotherapist

Geoff Buckley

Lay Summary Lead & Technical Author

Greg Booth

Physiotherapist

Vandana Luthra

Research and Development Department Officer

Dr Mansukh Unadkat

Retired GP

Helen Hedge

Patient Member

Juliet McQue

Patient Member

Project members

There are a number of PPI group vacancies, please email anthony.gilbert@nhs.net if you would like more information about dates and joining the steering group.

Anthony Gilbert

NIHR Clinical Doctoral Research Fellow

Dr Jeremy Jones

Primary Supervisor

Professor Maria Stokes

Academic Supervisor

Professor Carl May

Academic Supervisor

Rosalind Moss

Clinical Lead Physiotherapist

Professor John Skinner

Consultant Orthopaedic Surgeon

Why I joined the group

Communication skills are essential for healthcare professionals. Effective communication and video presentation about various physiotherapy treatments may reduce outpatient attendees. I have experience of healthcare following my three spinal operations and post op chronic pain management and bring a patient perspective to the steering group.

Mansukh

I was involved with Anthony’s pilot project and we found some of our patients coming from so far away videoconferencing was a great way to do consultations. I am also a patient myself and having to work full time I would like more opportunity for services like the NHS to use these technologies. As a clinical researcher I bring both a clinician and a research perspective to discussions with the steering group.

Anju

Many patients at the RNOH have to travel long distances to appointments lasting as little as half an hour. They often arrive tired or in pain flare ups as a result of this travel. Recognising when alternative methods of communication for chronic pain patients to attend appointments could be very valuable. I am interested to see whether or not this would improve attendance rates or reduce cancellation rates? I can bring a clinician perspective to discussions.

Greg

There has to be a viable alternative to traditional, costly, face to face consultations at the RNOH. I am motivated to be part of a fresh alternative that benefits patient care by saving their time and energy to attend appointments.

Helen Harte

I have been a patient at the RNOH since 2003 having had 4 operations here. I really appreciate having a world class hospital on my doorstep and I feel lucky to have my surgeons here as opposed to my local general hospital. I feel that this is my opportunity to give back a little bit. My background is working in health labs, specialising in histology. For the last 18 years I have worked in a GP surgery as a Medical Notes Summariser. Hopefully my work experience and as a patient I can bring something to this project.

Juliet

My abilities to make the project a success by way of my work as a technical author. I hope to bring good English to the project!

Geoff

I have been coming to the RNOH for just over 2 years and I have had a cartilage transplant and two knee replacements. I have been using the physio department for a while. The physio here at Stanmore is amazing. I have signed up to join the group as I am interested to see how things could possibly change, what the future might hold. Its very exciting and a pleasure to be a part of it. I bring a patient perspective to the group.

Helen Hedge

                          Please email anthony.gilbert@nhs.net for more information

PPI steering group meeting schedule

Phase 01

24th September 2018


Summary
Presentation

Phase 02

18th March 2019

Phase 03

TBA

Phase 04

TBA

Instagram feed

Funding body

Anthony Gilbert holds a Clinical Doctoral Research Fellowship, this research is supported by the National Institute for Health Research (NIHR), the Royal National Orthopaedic Hospital and the University of Southampton.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.​