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eHealth to deliver pain rehabilitation

by Leila Heelas | 6 months ago | in Pain Management
Horizon 2

Optimise Pain Rehabilitation Unit (OUH NHS FT) developed a digitally delivered eHealth pain rehabilitation programme aligned with a combined physical and psychological programme as outlined in the NICE low back pain guidelines. It was also based on available literature using quality improvement principles. We pre-recorded presentations and saved them as MP4 videos that could be viewed on phones, tablets or lap tops and sent an accompanying hand book, exercise guidance and exercises. Patients were also directed to follow a video of stretches on our website. Physiotherapists telephone participants pre- course and then at 2 week intervals for 8 weeks. We are now converting to Microsoft teams group follow-ups. We are evaluating this using microsoft forms for outcome measures which are emailed to participants and via survey of content, patient experience and digital issues.

Next we are moving to online group pain management programmes.

We also have a guided self help delivered by a psychology assistant for patients waiting for pain management programmes and deliver Telemed or video calls appointments with physiotherapists and psychologists for assessments and individual follow-ups. We are evaluating patient's experience of Telemed and video call appointments with semi-structured surveys.

Early feedback suggests that this format is helpful for people who are working, living at distance or who have childcare responsibilities that would preclude them from attending face to face appointments. Patient survey suggests that service users value the opportunity to remain in contact with the service whilst keeping safe.

We had concerns about the potentially didactic nature of the delivery but used CBT principles both with telephone support and with the online content. We also matched the baseline demographics of our Get Back Active participants with the baseline characteristics of a published trial using a similar methodology.I'm not sure eHealth would be as effective for people who are very depressed or distressed. These patients have been offered individual sessions with the psychologist or physiotherapist.

We are also planning online live weekly exercise classes for people with pain, one stretch and strengthen, one stretch and cardiovascular.

What is needed to sustain the change?

Funding for out medical illustration department to make high quality video recordings to improve the audiovisual quality of the content.

Better wifi quality, calls often cut out.

Continued access to Microsoft teams and MS forms. Access to a private you tube channel so that content can only be viewed by participants we have assessed and discussed treatment options with first.  If we used youtube studio, we could prevent downloading and also restrict access.

We could do with a  camera and microphone to enhance the quality of live digital delivery.

Following evaluation, we would need to run this as business as usual alongside face to face delivery which needs consultation with the CCG.


What is your region?

South East

edited on Jul 13, 2020 by Kyle Beacham
Leila Heelas

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Diarmaid Ferguson 6 months ago

Hi Leila ,
thank you for sharing your experience and expertise.
As you mentioned the CPPP is a major recommendation of NICE but has not been implemented nationwide apart from a few places .( such as your own excellent service)
Do you think a digital approach has the potential to plug this gap nationally ?

Reply 0

Leila Heelas 6 months ago

Hi Diarmaid,
I certainly think it has the potential to reach more patients and perhaps in a way that fits around their own commitments with work etc. It still requires time, clinical expertise and investment. If it was part of a research study with a dissemination strategy that involved national roll out, then yes, it would be possible. Like the iBest programme, however even this has not been adopted universally despite being free of charge. When I spoke at the first NBP-CN conference I had the sense that people were dubious about their trusts investing in a potentially time intensive rehabilitation programme. I think this issue remains, however I think that if surgical teams and operational leads supported rehabilitation teams developing business plans, which evidenced cost avoidance / improved patient experience / lower spending on medications, injections and surgery then it would be possible, whether F2F or digitally delivered. Even better if this could be demonstrated with research. There is no reason why the same team could not deliver both F2F and digital. We have an opportunity now that we have access to better software, Attend Anywhere etc which I think we should seize. What do you think would be helpful?


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Carol McCrum 6 months ago

Status labels added: Investment in technology, Pathway Redesign, Patient activation, Patient selection, Technology (software/ apps), Video consulting, Virtual consultation, Horizon 2

An excellent innovative strategy to support online delivery of PMP and ongoing support that could benefit from scaling out and support to implement - IT and funding to support professionalism of online resources

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Carol McCrum 6 months ago

The idea has been progressed to the next milestone.

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Greta McLachlan 5 months ago

Status labels added: Effective Team Working, Guidance, Health & Wellbeing, Supported Self Management, Telephone Advice, Telephone Consulting

Status label removed: Pathway Redesign

Reply 0

Greta McLachlan 5 months ago

Status labels added: Collaboration, Prim/Sec/Com Integration, Shared Decision Making, Staff & Patient Collaboration

Reply 0

Kyle Beacham 4 months ago

Status labels removed: Collaboration, Effective Team Working, Guidance, Health & Wellbeing, Investment In Technology, Patient Activation, Patient Selection, Prim/Sec/Com Integration, Shared Decision Making, Staff & Patient Collaboration, Supported Self-Management, Technology (Software/ Apps), Telephone Advice, Telephone Consulting, Video Consulting, Virtual Consulting

Reply 0