In Scotland, NHS Highland has implemented a ‘hub and spoke’ model of remote rehabilitation classes; the 'hub' being a central location where the physiotherapist is based, delivering a standard rehabilitation class to a group of patients; the ‘spokes’ being one or a number of different remote centres where further groups of patients are based who can also take part in the class. This model offers a service not currently available in many remote locations where the sparsity of patients makes the formation of a class unfeasible.
The main ‘hub’ locations now running this service are:
- Caithness General Hospital (physiotherapy gym)
- Fort William Health Centre (physiotherapy gym)
The ‘spoke’ sites are:
- Lawson Memorial Hospital, Golspie (Cambusavie Unit)
- Broadford Hospital Skye (Main Physiotherapy Room)
To maximise the usage of equipment, and to reach as many remotely based patients as possible, ITTS have developed a flexible model which can move around to different locations, depending on demand. The sharing of equipment across different patients groups such as COPD, cardiac, stroke, etc. is also being encouraged.
Changes to the equipment procurement and installation process and staff shortages/changes in personnel delayed implementation but the new service is now up and running, as of August 2013.
A link between Fort William Health Centre and Broadford Hospital has now been established with classes running from October 2013.
It is hoped that the new service will be further extended to sites at Portree Hospital, Skyle (hub) and Migdale Hospital, Bonar Bridge (spoke) at a later date.
Hub: Caithness General Hospital, Wick
Spoke: Lawson Memorial Hospital, Golspie
A group exercise class for pulmonary rehabilitation is now up and running between the physiotherapy gyms at Caithness General Hospital (hub) and the remote Lawson Memorial Hospital in Golspie (spoke), 50 miles to the south.
Currently there is a physiotherapist at both sites. The aim will be for one physiotherapist to deliver the class to both locations with a technical instructor (TI) to assist at the remote end.
The class can take a maximum of 12 patients: 8 in Wick and a further 4 at the remote site in Golspie (this is determined by the size of the rooms).
Each patient is assessed and given a personalised exercise schedule which they then follow during the exercise class. There are a number of exercise stations: exercise bike, stairs, weights, etc. and the patient works at each station until a certain time has passed or the correct number of repetitions has been completed. The physiotherapist is on hand to guide patients through the exercises and monitor their progress, checking blood oxygen saturation levels.
The patients can see, hear or even speak to each other over the VC and recent observations reveal both patients and staff are very accepting of the technology. An added benefit of the VC link is that it provides an opportunity for the delivery of shared patient education at the end of the class such as advice on diet or smoking cessation.
Finland continues to implement a remote rehabilitation service via VC to patients in the remote areas of Utajärvi, Vaala and Ii (northern Finland). A physiotherapist runs the class from her office to a group of 6 patients who connect via VC units installed in their own homes. These patients suffer from multimorbidity with chronic diseases such a stroke or heart disease and have difficulty accessing rehabilitation, either through distance or frailty or because of health staff resource limitations. Group-based rehabilitation will improve physical and social wellbeing of patients and in many cases enable them to stay at home for longer.
The first group class (6 patients) was run from January-June 2013; a second group began in September 2013.
Work is ongoing to improve broadband connections in the implementation area to allow more patients to use the service.
ITTS Ireland have implemented this service for the rehabilitation of COPD patients based in the North County Clare area of Mid-West Ireland. Historically, a physiotherapist travelled to see each patient face-to-face. With patients spread across a wide geographical area, often in remote and hard-to-reach locations requiring a ferry trip (Aran Islands), this approach took a lot of time and resource. A centrally based physiotherapist is now able to take a class from the clinic and be joined by remote users via VC installed in the patients' homes (following a site safety assessment). Time saved travelling can be spent seeing more patients, thus addressing the long waiting list for rehabilitation services. The classes are also designed so as to provide social interaction for patients who, by very nature of their condition, may be subjected to social isolation.
|Remote users join a
using VC installed in
Patients take part in rehabilitation class, both on site
Vidyo video conference equipment and software was identified as the most suitable and is now installed at the Physiotherapy Unit, Ballyvaughan Primary Care Centre, where therapy will being delivered from.
Following the success of the first sessions in January-March 2013, an 8-week block of remote rehabilitation clinics was delivered to assist patients with chronic obstructive pulmonary disease (COPD) across the North County Clare area. A schedule of classes was carried out in October/November 2013 with feedback suggesting a positive experience for all involved. A further schedule of classes is planned for a new patient uptake in January 2014.
Work is ongoing to improve broadband connectivity in the implementation area to allow more patients to use the service.
Sweden have implemented this service for the benefit of patients who live in remote areas surrounding Umeå and who cannot access rehabilitation classes, either through distance, sparsity of patient numbers (making formation of classes not viable) and through patient concerns about exercising alone.
The project was rescoped to deliver to a combination of patient homes and local health centres, causing a delay in implementation. However, enthusiasm remained high and, with equipment and staff now in place, the first classes began in May 2013.
A transnational knowledge exchange workshop for physiotherapists interested in using VC technology to deliver rehabilitation classes took place in September 2013. See our Events section for further information.