Veteran amputee telerehab call

This guide was produced with input from patients and their families and health and social care practitioners.

We refer to people having the remote appointment as patients, but this includes people receiving social care (for example, help with ‘activities of daily living’ and staying independent). 

We refer to the people providing the care as practitioners - this includes healthcare staff (such as doctors and physiotherapists) as well as social care professionals (like care workers, social workers and community support workers).

Remote versus face-to-face appointments

What are the benefits of remote appointments?

Remote appointments have a number of advantages. You don’t have the stress of travelling to the hospital or parking, and you can talk to the practitioner from the comfort of your own home. It may also be easier for your family to be involved and there is less risk of infection (e.g. COVID). Of course, there are also benefits to the environment when travel is not involved.

Are remote appointments as good as face-to-face ones?

The answer to this question is – it depends. For some people, it may be necessary to be seen face-to-face, for example:

  • those experiencing difficulties with balance and falls; or
  • where a hands-on approach is needed.
For others, it may be possible to do everything remotely. For example:

  • receiving advice and information;
  • problem-solving issues that may have arisen; or
  • reviewing exercises.

I met over Zoom and was glad to be able to see the person I was speaking to. The meeting was friendly making it easy to share information. Because my memory is bad I wrote down a few notes of the things I wanted to cover specifically on the call. I benefited from some follow-up calls to clarify any questions I had, to review my technique with the physio and discuss progress.

I think remote physio can have real benefits in certain situations, such as where the effort for the patient to attend the appointment means they may not be able to do as much at the appointment as they could if they were using video/Zoom. I would definitely want to mix it with face-to-face meetings, perhaps at the start and partway through.

Patient with Multiple Sclerosis

How does it work?

How will a physical assessment work if I am not in the same room as the doctor or physiotherapist?

In many ways, the appointment will be similar to a face-to-face one – the practitioner will usually begin by asking you about your medical history and symptoms, and the problems you might be experiencing. You should describe how you are feeling as clearly and thoroughly as possible, and try to be precise – for example, you could use a single finger or a pen to point to where the pain is coming from.

Your practitioner might send you something like a questionnaire to complete before the appointment. This will help them to understand your condition and the best way to treat it. 

They might also ask you to carry out some physical tests or exercises – like asking you to walk across the room or showing how you move from sitting to standing. Make sure you have enough space around you and try to stay in full view of the camera while you do this. If you have a willing family member or friend, they can help to position the camera so the practitioner can see you.

Technology concerns

What if I struggle with using technology?
If you don’t feel confident with technology, you are not alone. Consider the skills you have that you might not have thought about – like browsing the internet, sending e-mails or having a Skype or Zoom call with family or friends. Find out if there is a simple user guide that can be downloaded online or provided by the health or social care service before your appointment.
Prepare as much as you can in advance– look at our checklist and how-to guide. Don’t worry about making mistakes – it takes time to get used to new technology and practitioners will most likely have experienced this themselves!
Lots of people ask a family member or friend to help them set up new technology, or for support the first time they have a video appointment with a doctor or physiotherapist. Is there anyone who can help you? You could also have a practice call with a family member or friend before your actual appointment.
You can also get help from other places– see our digital skills section and useful resources below.
Don’t forget that there is also the option of a telephone appointment– this might not be as good for physical assessments, but it will allow you to stay in contact with the health or social care service until you can be seen in person.

Do not give up if you experience technical problems at first. You will find that video appointments get easier with time and perseverance.

Patient with low back pain

Be prepared: useful info, guidance and top tips

What technology do I need?

In order to have a remote appointment you will need access to the following technology:

  • Device – a PC, laptop, tablet or smartphone
  • Camera – built into smartphone or tablet, may be built in or attached to laptop or PC
  • Microphone and speaker – usually built into the device, but an external headset may improve sound quality
  • Video calling software (e.g. Attend Anywhere) that is compatible with your device. The practitioner should let you know which program will be used. (Note: if using a smartphone or tablet you may need to download an app first)
  • A reliable internet connection - if you have ever had a video call (e.g. with family or friends) and were able to see and hear the other person clearly, your internet connection should be fine. Home broadband may be more reliable than mobile broadband.
  • A mobile or landline telephone – to use in the event of technology failure

If you have a choice, some devices are better than others for assessing difficulties with movement:

  • Desktop PCs may be more difficult to change the camera angle
  • Smartphones and tablets are more portable and can be used for assessments, but have a smaller screen, and sound and camera quality will depend on the device
  • Laptops may be positioned fairly easily and have a better battery life

Get familiar with the technology

When you know you have the technology you need, doing the following before your appointment will help you feel more confident on the day:

  • Familiarise yourself with details of the appointment and any instructions or guidance on using the video consultations software.
  • Log in to the platform you will be using (e.g. Attend Anywhere) and check the settings.
  • Have a practice call if possible, ideally using the same device you will be using on the day (Attend Anywhere has a ‘test zone’ that you can practice in).
  • Follow any instructions provided by the practitioner and make sure you select the correct waiting room (e.g. in Attend Anywhere) if you are given a choice.
  • Learn how to make use of screen sharing and chat/message boxes to share information.

Guides to commonly used programs for video consultations

Your practitioner will tell you which program they will be using for your appointment. Below are links to guides for some of the most commonly used ones.

Attend Anywhere: Patients’ video guide to Attend Anywhere by NHS Near Me. Online PDF patient guide on how to use Attend Anywhere. Troubleshooting guide for patients for Attend Anywhere.

AccuRx: Information for patients from the AccuRx help centre.

Microsoft Teams: There are lots of video tutorials for MS Teams on YouTube, from beginners to more advanced users. Here is a 10-minute general tutorial.

Zoom: Simple, 8-minute tutorial on Zoom

Be prepared: things you may need

There are a few things that you may want to have to hand in case they are needed during your appointment, things such as:

  • A list of topics you want to cover – but remember that time may be short so choose the three most important things to discuss. The rest can be covered if you have time at the end or in a later appointment. 
  • A medication list, completed questionnaires, diaries or any other documents requested by the practitioner.
  • Any photos or videos requested by the practitioner - some practitioners may ask you to take a photo or record a video before or after the appointment so they can monitor your condition.
  • Any resources or information sent to you before the appointment - such as advice leaflets or exercise sheets (not all practitioners will send things in advance).
  • Equipment such as walking aids, in case you are asked to demonstrate using them.
  • Patient-friendly downloadable guides illustrate the series of steps in a typical physiotherapy journey. The guides by Design Science – Physio by Video focus on physiotherapy but might be useful for other clinical settings too.

Consider the space you are using

Make sure you are in a private, quiet, well-lit room. Avoid glare on the screen by facing the light source (e.g. a window) rather than having it behind you. 

Try to find a space that is free of obstacles, where you have enough space to move around – you may be asked to demonstrate walking or other movement. If you only have a small space, it may still be possible to do all or part of the assessment - talk to your practitioner if you have any concerns.

Try to avoid any interruptions (e.g. from children or pets!).

If you are worried about the practitioner seeing the inside of your home, remember they are not there to judge you, they just want to make sure it is a safe environment for you to live in and move around in.

Practical advice

Before your appointment:

  • Think carefully about how to describe your condition or symptoms, and be specific about details – for example, the exact location the pain is coming from, what triggers the pain and whether it is constant or intermittent.
  • Wear bright and contrasting colours to help the practitioner see your movement on the screen – for example, different coloured trousers, socks and shoes.
  • Place your smartphone, tablet or laptop somewhere stable. Try to move towards/away from the device rather than move it.
  • Consider whether you have a family member, friend or carer who can support you during the appointment (e.g. in using the technology, holding the camera or taking notes) so that you can concentrate on what is being said.
  • If you are hard of hearing, consider using a headset to cut out background noise – but if you have wired headphones, remember to remove them before walking away from the screen!
  • If you have a telephone appointment, check whether you have any call blockers or guardians on your phone. If the practitioner is calling from their workplace the number may be unknown or unrecognised.

At the end of the appointment:

  • Check your list to make sure your key questions have been covered
  • Ask the practitioner to summarise what was discussed, or to explain anything that is not clear. 
  • Make sure you understand what the next steps are.

Tips for people recovering from COVID

  • Talk to the practitioner and try to arrange appointments at a time of day when you feel less fatigued. Video and telephone appointments can be done from your bed if necessary.
  • You could ask a family member, friend or carer for support during your video appointment. They might be able to help you remember details from the appointment, set up the technology or provide physical support during assessments.
  • Pace yourself – start small and don’t try to do too much.
  • Try to set personal, realistic, short-term and medium-term goals – for example, “In a week’s time I want to walk for 5 minutes a day”.
  • If you do not meet your goals, try not to be anxious:
"Don't beat yourself up if one day you do not feel well enough to do what you have set yourself." (Post-COVID patient)
  • Keep a diary of your activity and look for patterns and improvements.
  • You could use a wearable activity monitor (like a Fitbit) to monitor your activity or heart rate – but remember these are not medical devices!
  • Maintain a good diet and keep a record of it.
  • Recovery will take time and there will be highs and lows – but you will gradually improve.
  • You might find it helpful to join a support group (like Long COVID Support) to talk to other people recovering from COVID. Try not to compare yourself with others too much – COVID affects everyone differently.

Resources for people recovering from COVID:

Long COVID Support is a peer support and advocacy group for people living with long-COVID. The website includes lots of resources including details of local support groups, videos on managing fatigue and where to get further help

NHS England/NHS Improvement - Your COVID Recovery is a website designed to help people recover from the long-term effects of COVID and support them to manage their recovery

Downloadable checklist and how-to guide

Someone close to me has a remote appointment. How can I support them?

Patient and carer having video appointment

There are lots of ways that you can offer support as a carer, partner or family member. You could:

  • help to set up the technology or hold the tablet or smartphone during the appointment.
  • help to make sure the room is safe and free from obstacles.
  • help to change the position of the camera as needed so that the practitioner can get a clearer view of your partner’s posture or movement.
  • stand close by to make sure they do not lose their balance when they are showing the practitioner how they move about.
  • help them to move their limb if they struggle with this, so that the practitioner can see whether the limb looks to be stiff or weak or painful.
  • you can just be there to listen, take any notes, or provide moral support as you would in a face-to-face appointment.

Feel comfortable to ask both the practitioner and your partner how you can help so they can get the most out of the appointment.

“If you have a partner, it is very much a team effort. They can provide gentle encouragement and motivation, moral as well as practical support.

My wife would count the number of steps I would do three times a day, and she also kept a record of all that I ate each day.”
(Post-COVID patient)

D-PACT: Senior couple communicating remotely.