Can Telehealth truly be an effective tool for helping patients with persistent pain?

With the COVOID-19 crisis upon us we as health professionals have been scrambling to embrace Telehealth as a feasible and viable service offering for our patients.

Through many of the social media forums there has been much talk around Telehealth considerations such as potential patient uptake, and the appropriateness of this alternative for achieving reasonable outcomes.
When considering the efficacy for my patients with persistent pain, I whole heartedly believe Telehealth is as effective, if not more so then face to face Pain Management education and skills development sessions delivered by Physiotherapists for the following patient and therapist reasons:

The advantages of Tele-health for our patients with persistent pain include:
i. This medium being more appropriate for patients whom have previously been manual therapy reliant, when same’s not clinically indicated for their pain experience.
ii. Improved access to supervision where appropriate i.e. injured workers in RTW space with RTW programs can “check in” without the need to interfere with working hours. Sessions can be undertaken in allocated breaks and be incorporated much of the time into their weekly routines without impacting completion of their certified hours and days.
iii. More convenience, and less commuting as there is less travel required to and from our clinics or other rehab facilities – and as such less sustained postural stress/escalation of symptoms.
iv. Better consistency – as software such as Physitrak can be set up with adherence trackers, and reminder messages for the patients daily to not only help keep them accountable, but also allow us to monitor daily and weekly compliance.
v. Promote independence and flexibility – again by reducing the need for manual therapies, thereby ensuring greater self-efficacy, understanding, and ownership of one’s presentation, goals, active management strategies and outcomes.
vi. Videofile recordings – as patients can re-listen to consultations if they need to clarify any components raised. Often Pain Management can be “information overload” for many patients – so being able to revisit education elements can help with consolidation and application of active pain management strategies.

For ourselves as Physiotherapists working as Pain Management Educators the advantages include:
i. Reduced Physical contact – removing the manual therapy elements (and often perceived obligation) from the equation, ensuring messages aren’t blurred from our end as to our role being that of structured guiding and monitoring for each patients success at developing their own effective pain management toolbox.
ii. Freedom of location and times to consult from, allowing us as clinicians more flexibility and in turn broader access for more pain population types (patients working nights, regionally or internationally based etc). Access via secure messaging systems can also be set-up which allows you the ability to communicate with the patient about any queries or concerns they have outside of consultation times, without the need necessarily for direct phone calls or follow-up consultations. iii. Greater efficiency and engagement with consultations – Less “chit chat”, and time better spent on assessment, education, goal setting and reflection elements.
iv. Maintaining caseloads and reducing clinic gaps by broadening the diversity and accessibility of our service offering from traditional face to face consultations.
vi. Standardised Patient Pathways – allowing ourselves set milestones to abide by when reassessing patient progress through this medium and determining in a timely fashion when inter-disciplinary referral, investigation or collaboration is necessary to optimise biospychosocial approaches to each patients care.

In summary, the current crisis has taught us as healthcare providers to rapidly reflect, understand, and adapt to new approaches to delivering our messages for helping all patient types, not just those with persistent pain.

Ironically though the “recalibration” we are all currently undertaking, is very similar to what we have been asking of our patients suffering from persistent pain to do for many years now – Be adaptive! Telehealth allows both patients and providers to work well within the biopsychosocial framework to improve understanding of persistent pain, development of coping strategies, and attaining better functional outcomes.

For further information please visit one of Australia’s undisputed guru’s in the Telehealth field, Karen Finnin. www.karenfinnin.com.