The impact of Covid-19- Thinking outside of the box

The impact of coronavirus and recommended precautions on the ways we deliver our services has meant that we have had to transition rapidly in order to continue case management and delivery of rehabilitation services.

This includes the need to explore with clinicians engaging with our clients, how to best offer remote services to ensure that clients’ physical and psychological progress is maintained and continued, whilst supporting their emotional wellbeing ‘at a distance’.

Our clients are currently facing physical, cognitive and emotional challenges associated with not attending their usual therapy sessions.  Case Manager Emma Hicks at Unite Professionals is currently working with clinicians who have swiftly adapted to deliver remote Physiotherapy and Occupational Therapy by use of technology alongside the use of everyday objects and equipment at home.

Here is her reflection on providing case management services while self isolating:

As I write this, my client is entering week 7 of ‘rehabilitation lockdown’. He is not able to access NHS or private medical and rehabilitation services. He is at home with his partner, and home schooling their children. He sustained complex orthopaedic injuries and has ongoing medical and rehabilitation needs.

Patrick at Postural Health Ltd and Liz at Evergreen OT Services are committed to providing ongoing, high quality rehabilitation. This is currently via ‘Virtual visits’ using mobile phone and video facilities such as WhatsApp.

Examples of joint remote working include the activity analysis of use of garden tools to promote a graded treatment programme to continue to improve upper limb function, balance and mobility, exercise tolerance and satisfaction in ‘doing’ and achieving normal everyday tasks. The psychological gain in ability to achieve normal everyday activities around the home should not be forgotten. The emotional impact on the effects of the Covid-19 pandemic upon client and family needs to be considered and monitored.

We have been thinking ‘outside the box’ in ways of using existing tools, for example, garden strimmer and chainsaw, and items such as a bicycle and pop up swimming pool. Exploring how these could be incorporated into rehabilitation has proved positive.

With recommendations and funding approved we have been able to provide our client remotely with a knee brace ( using company advice and video support for how to measure for and fit this), a balance dome (for core stability exercise), a heater for the outdoor ‘pop up’ pool, and flippers (to enable him to use the pool as a hydrotherapy environment). A turbo trainer for the bicycle and phone app mean that a bike training programme can be initiated. The use of the app means that progress and achievement can be used as part of SMART (Specific, Measurable, Attainable, Relevant, Time bound) goals which evidence therapy interventions whilst highlighting to the client’s progress he is making.

As a team, we are in regular contact with our client to review progress and adjust the home rehabilitation programme including balance, range of movement (ROM) and strengthening exercises, stretches, posture advice and pain management. We’ve also had discussions to give advice on sleep and fatigue, routine, number of repetitions of exercises, frequency of exercise and use of equipment.

This is done via clients preference to use their mobile phone discussion and WhatsApp video. The client can demonstrate his movement and function ‘live’ during the video link.

The client has adapted well to the introduced changes, keeping a diary to note frequency of exercise, impact on fatigue, sleep and pain, and functional independence.

These regular remote interventions will further help to maintain patients’ motivation and allow us to monitor mood and emotional wellbeing.

Frequent communication with all involved continues with structured conference calls for updates and review. This is an opportunity to explore flexibility in our approach, guided by risk assessment and regular review of our intervention goals and objectives.

Business… but not as we know it!

– Emma Hicks, Unite Professionals Case Manager