Rehabilitation, physiotheraphy. Hand grasping/squeezing a medical tool.

A rehabilitation crisis

There are 13.9 million people with disabilities in the UK, many of whom are physically disabled. These physical disabilities require hands-on movement assessments, targeted rehabilitation plans and ongoing evaluation to meet their changing needs by physiotherapists and clinicians.
The Covid-19 pandemic and subsequent reduction in face-to-face appointments has meant people of all ages have received no rehabilitation with the need growing with recovering Covid-19 patients. The Chartered Society of Physiotherapy has described this as ‘a tidal wave of rehabilitation need’.
This has particularly affected those who are shielding because of health vulnerabilities who have had no face-to-face input for months. With social distancing measures continuing, this 'new normal' looks set to last for the foreseeable future and will disproportionately impact older people and those with health issues. 
In response to the crisis, clinicians have found new ways of working and are rapidly adapting and creating telerehabilitation solutions with little, specific guidance, training or support. Professional bodies and clinical networks highlight the marked variations in approaches used which are at risk of inequity and inefficiency with long-term consequences.
This project, led by Professor Jenny Freeman, Professor of Physiotherapy and Rehabilitation and funded by the National Institute for Health and Care Research (NIHR) and UK Research and Innovation (UKRI), is seeking to address these issues through the creation of a toolkit and training package for current and future clinicians. Professor Freeman is collaborating with researchers from the University’s Faculty of Health, the University of Warwick, and partners in NHS trusts and the social care sector across the region.
The project also builds on the expertise in digital health found in the University’s Centre for Health Technology

“Assessment is absolutely key to being able to deliver a targeted intervention – if you don’t have a clear idea about people’s baseline abilities or how they are changing then it’s difficult to effectively plan and progress someone’s treatment. This research captures people recovering from the coronavirus, but also the much greater number of people with other, pre-existing conditions, who have not been receiving treatment for an extended period of time. Rehabilitation is crucial for improving people’s quality of life and if there is one positive to come out of this situation, it is that people are now recognising this fact.” Professor Jenny Freeman

Stroke patients recieving physiotherapy treatment at Mount Gould Hospital in Plymouth

Covid-19 long-term

Many of the signs and symptoms experienced by Covid-19 patients are similar to those experienced by people with long-term conditions. This can include post-intensive care syndrome that includes impaired exercise tolerance, neuropathies, muscle weakness and severe fatigue. For those with more mild symptoms, prolonged mobility can also lead to deconditioning and weakness. In the more commonly affected elderly group, this can contribute to frailty and predispose to falls. 

The knowledge around distance-based methods for rehabilitation of these patients is limited. Physical symptoms – reduced ventilatory capacity, fatigue and weakness (common post-COVID-19) may not be reliably assessed and there is an overarching safety issue of physical assessments without a clinician physically present. This project will take the lessons learnt from working with Covid-19 patients across other conditions, extending its impact post-Covid.

Evidence-based guidance and training for telerehabilitation

Professor Freeman and her team will provide clinicians with clear practical evidence-based guidance training via an Assessment Toolkit and Training Package to enhance confidence and competence in delivering telerehabilitation for people with movement impairments/physical disability, including those recovering from Covid-19.  

Starting in July 2020, it is anticipated that this package will be rolled out within six months.

The project will improve clinician's confidence and competence in using telerehabilitation, facilitate the efficient management of the back-log of people with disabilities who have not been able to undertake rehabilitation during the pandemic and provide best practice for telerehabilitation that will inform future practice.

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Centre for Health Technology

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Online tele medicine isometric concept. Medical consultation and treatment via application of smartphone connected internet clinic.

Plymouth Institute of Health and Care Research

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