Telehealth – Video consultations

Luddite – A person opposed to new technology or ways of working

Technophile – A person who is enthusiastic about new technology

 Which one are you? During the restrictions on travel and interaction around Covid 19, I feel a lot of Luddites have been converted, through necessity, into technophiles. This has allowed ongoing communication and connection to our community, which previously would not have been possible. In a healthcare setting, this has meant a shift towards Telehealth consultations and appointments.

It comes under many pseudonyms (telemedicine, mHealth, E-Physio, E consultations) but in essence it is the use of phone call and/or video call apps to hold a Physio or Medical consultation.

Unlike the general public however, within healthcare we have to be mindful of patient confidentiality and data security. This makes the choice of whether to use Telehealth services a little trickier. We can be neither the Luddite or the Technophile. We need to embrace new ways of working but also be mindful of the checks and balances that need to be in place to make it a safe and effective form of treatment for patients.

Telehealth consultations have been carried out for years, particularly by health Insurance firms and in countries where there are areas of sparse population density (Australian Outback, Northern Canada, parts of Africa)

Given the current situation around Covid 19, there has been a surge in Telehealth consultations around the world, including Ireland. For example, in Scotland, there has been a 1000% increase in the use of Telehealth consultations since the beginning of Covid 19 restrictions.

A telehealth consultation has many advantages over a traditional face to face consultations but also has many disadvantages.

The advantages include the fact there are no geographical boundaries. You can consult you Physiotherapist from the comfort and safety of your own home.

Studies from the NHS in the UK have found that during a telehealth consultation, patients do a lot more of the talking compared to a face to face consultation. This is never a bad thing and forces us clinicians to be quiet and listen. Telehealth consultations are on average a little shorter than a traditional consultation and as all treatment is based on advice and exercise prescription, it forces the patient to take control of the injury and responsibility for rehab.

The major limitation of a Telehealth consultation is that we cannot perform a full physical examination. Saying that, there are many tools available now such as wearable sensors, that are cheap and allow us to get a lot of physical information regarding a patient that we previously could only get in clinic.

We also need to err on the side of caution when making an assessment online. This is to make sure we don’t miss any potentially serious issues going forward. If, during a Telehealth consultation, your Physio believes that your issue is something that needs to be seen face to face, then we make all arrangements to let that happen.

Overall Telehealth consultations offer a good solution at a time when face to face consultations are not possible. There are many potential uses for Telehealth and these all need to be explored. As long as we do so with due regard to its limitations then we can provide a safe and effective treatment tool.

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David Oliver: Telehealth and telecare need a different approach BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5108 (Published 28 November 2017)Cite this as: BMJ 2017;359:j5108

mabile BorgesDarioMScaAneliseMoreti Cabral(Physiotherapy Student)bLisandraAlmeida(Physiotherapy Student)cManuelaLoureiroFerreiraPhDdKathrynRefshaugePhDaMilenaSimicPhDaEvangelosPappasPhDaPaulo HenriqueFerreiraPhDa Effectiveness of telehealth-based interventions in the management of non-specific low back pain: a systematic review with meta-analysis. The Spine Journal Volume 17, Issue 9

Chaet et al.: Ethical practice in Telehealth and Telemedicine. J Gen Intern Med 32(10):1136 −40

Sara Shaw, Joseph Wherton, Shanti Vijayaraghavan, Joanne Morris, Satya Bhattacharya, Philippa Hanson, Desirée Campbell-Richards, Seendy Ramoutar, Anna Collard, Isabel Hodkinson and Trisha Greenhalgh. Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH. VOLUME 6 ISSUE 21 JUNE 2018 ISSN 2050-4349