Main themes from the National Evaluation of Remote Physiotherapy Services

1. Preference

• Patient preference is influenced by a range of factors including perception of accuracy and effectiveness of the consultation; convenience, cost, and availability for work/other responsibilities; accessibility, previous experience, performance and familiarity of technology
• Preference varies according to the remote approaches available and the purpose of the consultation
• Patient preference is significantly influenced by external factors such as a pandemic and perceptions of risk

2. Experience/satisfaction

• Patient experience/satisfaction is influenced by patient preference
• Key factors influencing patient experience are the quality of the technology, convenience in terms of travel and time away from work or other commitments and cost

3. Clinical presentation

Physical and mental health needs

• The individual physical and mental health needs of some people may present challenges for remote delivery especially where physical assessment is required
• Some individuals benefit from remote physiotherapy due to the physical and mental health needs they experience, for example, when discussing sensitive issues or when symptoms are aggravated by travel and different environments

4. Communication

• This includes learning needs, cognitive ability, vision, hearing and language 
• There is a perception from some respondents that remote delivery may not be suitable for some individuals with cognition, language, learning or sensory needs
• The potential of technology to enhance communication has not been evaluated

5. Safety / Perception of risk

• There is limited evidence for the safety of remote consultation or evaluation by services

5.1 Physical safety

• A key issue for patients at risk of falling especially if they are alone at home
• The exact location/address of the patient may not be known in case of emergency

5.2 Environment

• The home environment may have safety hazards
• The home environment may present issues for privacy/confidentiality

5.3 Clinical safety

• Accuracy of assessment and diagnosis may be compromised by not being able to undertake hands-on examination and/or reduced visual detail

5.4 Technology

• This includes, access, digital literacy, training, support, functionality, usability, familiarity, software compatibility

5.4.1 Confidentiality

• Issues in relation to information governance, in particular confidentiality and data protection

5.4.2 Performance

• Low quality technology may compromise patient safety issues

5.5 Infection control

• An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff

6. Convenience and cost

6.1 Cost

• No travel or parking costs with remote sessions

6.2 Time

• Remote sessions can be delivered without travel time or car parking challenges which will all save the patient time

6.3 Work/other responsibilities

• Less time and travel means that patients will feel less impact on their family lives

7. Technology

• This includes, access, digital literacy, training, support, functionality, usability, familiarity, software compatibility

• Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
• Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
• Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

1. Individual factors

1.1 Preference

• For some respondents, in person physiotherapy is non-negotiable
• Other participants, while preferring in person, acknowledged the importance of providing person-centred physiotherapy and are willing to work combining in-person and remote delivery

1.2 Experience/satisfaction

• For most participants the start of the pandemic was a difficult and stressful time with a high degree of uncertainty and rapid change
• During the pandemic experiences varied, for some it was challenging not being able to use their ‘hands on’ expertise and skills while others felt they had developed and utilised different skills
• In terms of work location, some participants working from their home felt isolated and missed the interactive and social parts of working with others
• Positive and negative experiences related to access to and performance of technology, effective leadership and organisational support

1.3 Professional identity

• For some respondents, therapeutic touch and ‘hands on’ skills are a fundamental part of their personal identity as a physiotherapist and essential for accurate assessment and effective treatment
• Some physiotherapists felt that remote delivery challenged the identity of physiotherapy as a profession and would impact on training for the next generation of the physiotherapy workforce

1.4 Personal safety/perception of risk

These relate to infection control

• An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff
• In relation to the working environment, the need for policy around sharing equipment, for example, computers and headphones, was raised

1.5 Knowledge and skills

This includes both clinical and technical skills

1.6 Response to change

• Many found the rapid change to remote delivery disruptive and challenging
• However, some saw it as an opportunity to develop new skills and 'think outside the box'

1.7 Leadership

• The effectiveness of transferring to remote services was felt to be dependent on proactive leadership including skilled management of change and team dynamics, flexibility and knowledge and confidence with technology

2. Safety/perception of risk

• There is limited evidence for the safety of remote consultation or evaluation by services

2.1 Physical safety

• A key issue for patients at risk of falling especially if they are alone at home
• The exact location/address of the patient may not be known in case of emergency

2.2 Environment

• The home environment may have safety hazards
• The home environment may present issues for privacy/confidentiality

2.3 Clinical safety

• Accuracy of assessment and diagnosis may be compromised by not being able to undertake hands-on examination and/or reduced visual detail

2.4 Technology

2.4.1 Confidentiality

• Issues in relation to information governance, in particular confidentiality and data protection

2.4.2 Performance

• Low quality technology may compromise patient safety issues

2.5 Infection control

• An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff
• In relation to the working environment, the need for policy around sharing equipment, for example, computers and headphones, was raised

3. Technology

• Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
• Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
• Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

• Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
• Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
• Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

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