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.
How Patient and Public Involvement is shaping the research
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
Effect 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)
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.
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.
Study Results
01. Review
Review of Previously Published Research
What is the effect of virtual consultations on patient workload?
02. Interviews
Interviews with Patients and Hospital Staff
What factors influence patient preferences for virtual consultations?
03. Patient Survey
Survey of Patients
What are patient preferences for the use of virtual consultations for orthopaedic rehabilitation?
03a. Covid-19 Study
The impact of Covvid-19 on the research
The search was affected by Covid-19 and as a result we have conducted some additional work.
03b. Interviews
Interview with Patients
How does COVID-19 influence patient preferences or virtual consultations?
04. Interviews
Interview with Patients, Clinical and Non-Clinical Staff
What is the experience of using virtual consultations after COVID-19?
PPI Group
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 Miller
Patient Member
Elayne Coakes
Patient Member
Diane Young
Patient Involvement & Volunteer Lead
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
Juliet McQue
Patient Member
Supervisors
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
Please email anthony.gilbert@nhs.net for more information
PPI steering group meeting schedule
Phase 04
TBA
Instagram feed
Funding body
Anthony Gilbert holds a Clinical Doctoral Research Fellowship, this research is funded by Health Education England and 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.
