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
Review of Previously Published Research
What do we already know?
Interviews with Patients and Hospital Staff
What do patients already know?
03. Patient Survey
Interviews with Patients and Hospital Staff
What are patient preferences?
Design a New Way of Working Using Digital Technology
What do these preferences look like in clinical practice?
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.
The research is split into four phases:
Effectiveness of Communication Technology (months 1-6)
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.
Burden of Treatment (months 7-12)
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.
Care in Orthopaedics (months 13-21)
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.
The Connect Project (months 22-30)
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.
Lay Summary Lead & Technical Author
Research and Development Department Officer
Dr Mansukh Unadkat
NIHR Clinical Doctoral Research Fellow
Dr Jeremy Jones
Professor Maria Stokes
Professor Carl May
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.
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.
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.
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.
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.
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!
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.
PPI steering group meeting schedule
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.