Recover from injury whilst at home
Something we have introduced more recently to the masses are video consultations. For this reason, I wanted to share my thoughts about the pros and cons of using video consultations when recovering from pain. I will be covering a few areas from diagnosis, communication, examination and outcomes. Essentially virtual consultations as a whole and most importantly how I have changed my mind about them.
This blog is particular aimed at patients/clients/anyone who is in pain/injured and is thinking about getting a video consultation to help with their symptoms. Clinicians/trainers may find some useful takeaways in here too.
COVID-19
Prior to COVID-19, I would only use video consultations for athletes, working with us when they were travelling. These are people I had already seen, met, knew their history and was working with for a period of time. I must admit I initially had some reservations about how useful they would be and almost seen them as inferior and more of a means to an end.
We couldn’t see the athlete face to face, we needed to check in, we needed to keep them progressing, so it was the best option available. Over a period of time I got more accustomed to them and could really see how much could be done and achieved in that capacity.
When we had to make the decision to close our doors for face to face due to COVID 19, I once again could feel that sense of reluctance coming back. My athletes seemed to be on board with the virtual appointments and were getting great benefit, but I feared resistance from current patients and new patients alike.
And resistance there was.
However, we did move a chunk over to virtual and have also been seeing some new patients from all over the world through these means.
Now that these have been running smoothly for a period of time I wanted to share my honest thoughts with you. I am going to go through this from back to front to add some context. For that reason, the first thing I am going to discuss are outcomes.
Outcomes
It could be argued that outcomes are the single most important thing to the patient/client, to you. When someone comes to see me they are often in pain or injured and want to know how they can reduce their pain and get back to doing whatever it is that the pain/injury is stopping them from doing.
I always spend a considerable amount of time diving into their goals, any time frames they have, what they have done in the past and any barriers they currently have to getting from A to B.
I also like to ask my clients/patients their expectations of me.
Do you have any expectations of me? What is it you feel like you want me to do/offer that you think may help? How quick do you think we can achieve this?
It is important to then reconcile their expectations to how you can actually help them. Some patients believe hands on treatment is what they need. This is one barrier we had to educate our clients around. Some want information on what’s going on. Some want some advice how they can help themselves. Each visit is unique.
Coming from a hands-on manual therapy background, being an osteopath by registration, often I get patients come in and specifically believe the hands on aspect of the care is
1) What they want.
2) What they need.
3) What is going to help them the most.
Whilst I would agree that manual therapy can help, may reduce symptoms and can be included in recovery for a lot of pains and conditions. It is rarely my core focus or primary treatment strategy.
Treatment Approach
The Hardiman Performance treatment approach can be probably split into (3) core areas.
- Initial Clarity – Providing context, clarity, understanding and diagnosis. – This happens by fully exploring the case history and reconciling with examination findings.
- Acute changes – Altering symptoms short term to provide some immediate benefit. These benefits may include pain relief, restoration of movement. For this we may use, simple movement based exercise or manual therapy (practitioner/patient applied).
- Chronic changes – Altering symptoms long term to provide meaningful improvements in quality of life. These may include improved function, strength, control, confidence in movement or return to sport. This is achieved through progressive exercise and lifestyle alterations – diet, sleep, work.
Outcomes are dependant in part or on all of the above in varying degrees in each patient.
In the context of a virtual consultation. All 3 areas can still be approach via a virtual consultation.
In fact, I have found that there is one key benefit to a virtual consultation over an in person, face to face visit.
Over virtual means and without physical contact the patient is unable to rely on the practitioner for fixing. Instead they are forced to become active participants in their recovery. Listening to advice, self-applying manual therapy should they wish, doing their rehab-based exercises and adding changes to lifestyle when required.
This engagement is predictive of better outcomes. It empowers the patient and gives them the ability to self-manage, building confidence and decreasing reliance on the practitioner.
If you visit our social media channels or talk to any of our patients past and present, you will know that we are very much a clinic who ensure our patients are active participants in their recovery. We have a manual therapy background so yes; we will provide manual therapy if patients would like us to or if we feel it will add benefits to their recovery short or longer term.
We don’t however ever have a manual therapy only approach to recovery. In fact, manual therapy is not our core treatment strategy. Our approach is always multifaceted and using virtual means has allowed us to double down on the key messages in which we have always provided our patients.
A message where we educate, dispel myths, provide context and reassure. A message where we encourage positive change, movement, exercise and active participation.
Having rolled the virtual world out to the masses and now had some time to reflect on how it’s going. I have noticed 3 things.
1) Outcomes as a whole have not changed. Patients are still doing well under our care. A similar percentage improve at a similar rate as previous.
2) Some have engaged more with the process and are doing better than previous. Some less.
3) Patients new and ongoing are very happy with the current set up and some dare I say actually prefer it.
The honest truth is that I still prefer face to face by the way, anyways I digress.
Research supports the idea that patients with higher self-efficacy do better long term. Self-efficacy is this context refers to the patients beliefs and confidence in their abilities to cope, manage, control pain and recovery. Providing the right education at the right time can be the key to this.
This education is provided in the first appointment with your practitioner and I am a firm believer that most of the important stuff which enables a good outcome for a patient when working with a professional happens within the very first appointment. Subsequent visits can be used to iterate and top up on the education process.
Let me tell you why.
The Initial Appointment
Before I do that, I will just say that this is the reason I like to schedule a fully hours initial appointment with my patients. Time to explore in as much detail as possible is needed.
The initial appointment is our chance as practitioners to fully understand the patient’s current position, their pain/injury/history, their thoughts/feelings beliefs, their anxieties/fears/worries. As other health professionals will attest is important to take the time to fully explore this in as much detail as possible, as this subjective part of the examination process forms (in most cases) 90 % of the information needed to make a diagnosis and impactful treatment plan. The other 10% being made up of physical examination findings.
Once we understand as best we can we can then begin to help. And by help I mean, help you to understand your symptoms, dispel any myths, reassure around any fears or concerns and provide a plan to enable recovery navigating any barriers preventing it.
The plan will differ from person to person. Some needing more support and with others better at self-managing but doing what I have just discussed well and putting a plan in place for me is the most important.
It is vital to note that this can all be delivered via the virtual platform and I feel like once you get your head around it, it works super well.
There are some pitfalls though.
Pitfalls
I’m a people’s person, I like face to face visits. I feel like communication is easier face to face. It is a little bit trickier to read body language through video. That being said video consultations are light years ahead of telephone calls.
Most of the clinical examination is possible through video but for certain patients for example those with neurological type symptoms, we are unable to do those tests online. Face to face is essential for this.
Tech issues. Some people aren’t particularly techy. Although we use a simple platform with clear instructions, tech issues can still occur. We haven’t had many but here are two examples of ones we have had. Batteries dying, no audio. With both we were able to call and either rearrange appointment or rectify the issue.
We advise using a laptop or tablet for better experience, but some opt for smart phone use. The good news is that these types of consultation can be done on any of the mentioned. However, with phones I have noticed that sometimes examination can get a little challenging if the patients don’t have anywhere to prop up the phone. Using a stand for your phone can help to rectify this issue.
In terms of treatment, we obviously can’t do hands on via a phone but we certainly can teach self-manual therapy to help with pain relief if we deem that to be appropriate. Otherwise it’s no change to treatment – remember what I mentioned earlier.
Clarity, Acute Changes, Chronic Adaptations.
This process works virtually or face to face.
Positives
There are some additional positives on top of what I have mentioned earlier too.
The process is cleaner than face to face. Somewhat smoother. An hour is scheduled and it takes 1 hour, no commuting time, no traffic, little reason for lateness. It can be done anywhere, whilst travelling, whilst away at events and from the comfort of your own home.
It is literally a simple click button exercise from booking to confirmation to getting on the call. You don’t even have to speak to a single human being before the consultation if you don’t want to. I know this will suit some. We are of course available to speak via phone or email for those who need it.
Patients also seem to be, dare I say, more committed to their part in their rehab. It’s tough to make such a bold statement because as a whole I work with a motivated group of patients who are particularly compliant with their rehab and invested in their outcomes.
However, I have noticed a slight step up in compliance with rehab exercise and programming and the lifestyle stuff which supports it.
I have two hypotheses for this.
The first one is simple.
1)People have more time at the minute. Pretty self explanatory.
2)Because they can’t physically come into clinic and have manual therapy to relieve their pain, they are forced to instead take action/step up.
This can only be a thing for their longer-term outcomes. We are definitely seeing some great progress with patients through these means.
Finally, it’s great to be able to open up our clinic to others around the U.K/the world. People who have followed our stuff previously have been able to each out and get more personal help. For this reason, we will continue to offer virtual services along-side our face to face services when this is all said and done.
In summary, virtual consultations are working great for us so that we can continue to provide care to patients during these times and help a broader spectrum of patients worldwide.
I have become a fan and if you are thinking about seeing some virtually for your pain, I would recommend. Bookings for our virtual service can be made using this link.
I am however looking forward to the day we open up our physical doors again and see patients face to face. It’s simply one of those things I love to do.
Enjoy your day.
