Episode 1 – Empowered Beyond Pain Podcast: Talking Telehealth with Professor Peter O’Sullivan
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Episode Show Notes:
Systematic Reviews for Telehealth Rehabilitation:
Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017;31(5):625‐638. doi:10.1177/0269215516645148 https://doi.org/10.1177%2F0269215516645148
Grona SL, Bath B, Busch A, Rotter T, Trask C, Harrison E. Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. J Telemed Telecare. 2018;24(5):341‐355. doi:10.1177/1357633X17700781: https://doi.org/10.1177/1357633×17700781
75% of people with eligible for knee replacement declined the operation at 12months:
Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Simonsen O, et al. A Randomized, Controlled Trial of Total Knee Replacement. N Engl J Med. 2015;373(17):1597-606. https://doi.org/10.1056/nejmoa1505467
68% declined it at 24 months
Skou, S.T. et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials Osteoarthritis and Cartilage, Volume 26, Issue 9, 1170 – 1180: https://doi.org/10.1016/j.joca.2018.04.014
* please note this transcript is auto-generated and may not be 100% accurate*
“What it highlights is that coaching people to better health is a great way of caring for people rather than creating a dependence on them to come back and see us again and again”
Welcome to the ‘Empowered Beyond Pain’ podcast, proudly brought to you by Body Logic Physiotherapy. I’m Kevin Wernli, a physiotherapist and PhD researcher, and I’m joined by world leading physiotherapy specialists* and clinical researchers Professor Peter O’Sullivan and Dr JP Caneiro as co hosts. We’re based in Perth, Western Australia, and through this weekly podcast, we aim to make sense of science and bring evidence to your eardrums, to empower you to better health, and empower clinicians to provide the best care for people in pain. Each episode is full of practical tips and insights to help increase your understanding, and shift your behaviours to nudge you down the road to growth.
Welcome to the first ever episode of Empowered Beyond Pain, we’re absolutely thrilled to have you here. In this inaugural episode of season 1 we chat, from a distance of course during the Coronavirus pandemic, with Professor Peter O’Sullivan from Curtin University and Body Logic Physiotherapy. The conversation is mainly related to Frequently asked questions about Telehealth (Also known as, online video consultations). We talk about things like: how online physio helps without putting hands on people, avoiding unnecessary surgery, as well as the mechanisms behind how people improve and get out of pain. After the conversation, I summarise my take home messages, and we introduce the ‘to try today’ segment which is designed to help you turn information into action. This episode is proudly brought to you by Body Logic Physiotherapy, where the goal is simple, to empower you to better health. If you’d like to know more about how telehealth works, visit www.bodylogic.physio, and click on the Telehealth button. This conversation was also recorded a few weeks ago, and things may have changed by the time you’re listening to this, so keep an eye on the website to stay up to date. We hope you enjoy the conversation and remember to ask… is there more to pain than damage.
so people with the whole corona virus pandemic happening lots of practices are moving towards telehealth rehabilitation and it’s been some interesting research for example systematic review that showed that telehealth was as effective as face-to-face consultations for the management of musculoskeletal pain and injuries you know Alan can you kind of talk to how people get better or or how telehealth was proven to be just as effective as your in-person face-to-face consultations yeah it’s interesting and it doesn’t come as a great surprise to make it because I think what we’re learning more and more about musculoskeletal pain is the things that are really important around pain for people to have a clear understanding of what’s going on for them that’s around educating them but also to learn tools to get back in control of their pain and to regain function and so these are the traditional tools of like hands on pushing it massage or manipulation or kneeling and the body things around developing an understanding of building confidence and having strategies of getting back to function again and these are things that we can do just in this format and the way we’re doing it now and the beauty of video consulting particularly is that we can easily demonstrate to people so I can get up with an demonstrate movement and set a program up but I can also look at how you’re doing it so it’s got this capacity to both communicate and to watch and to modify behavior and set up a program that is what we would do in a normal consultation and the the disconnect in terms of you’ve been face to face with me putting on my hands on you not the key things that influence whether a person gets better or not but much more around do you understand what’s going on have you got a clear plan have you got strategies that you can implement to make changes to get you back to living again and are things you can do easily through telehealth so Pete Australian government deems physiotherapy as an essential service but you and the directors that audiologic physio have decided to only have online consultations so can you tell me about that decision yeah look I think it’s wonderful the Australian government sees physiotherapy is essential because we have such an important role in the community in terms of helping people manage pain but also other aspects of physiotherapy in terms of having health neurological and County of respiratory as well obviously our area is must little pain which probably represents the bulk of physiotherapists in the private sector we took a view that we had a social responsibility to care for our patients the best way we could and to us that was there was a growing risk that we ourselves as well as people coming into our practice could be carriers a Crona virus without our even our knowledge and because of that and we were seeing more and more highly anxious patients coming in looking at us as if we could be carriers that we felt it was actually untenable to provide a high level of care and with with a view that we could keep our ensure that we were keeping our clients safe so we decided last week that we would move to telehealth and the reason for that is essential essentially the fact that we felt we could deliver the same high levels of care through a safe environment that was safe for the patient’s safe for us and providing the care that they needed in the comfort of their home so it wasn’t a hard decision in that sense because we felt like that was the best way we could here both for our community as well as our staff here and the practice you know if you ask the general population what physiotherapy is I feel like the general consensus would be you know in physios obviously assess and treat pain and injuries and that provides some sort of hands-on treatment some massage and manipulations with some dry needling you know but it sounds like you know physiotherapy at least we’ve body logic has kind of changed a little bit so can you kind of contrast I suppose that that existing model of physiotherapy and perhaps what modern physiotherapy kind of looks like yeah it’s a great question and and I think probably one of the things that frustrates me most is when if I’m with a group people and they go so what do you do for a job and I saw my Visio they go are can you give monicker up drives me crazy because I think there is that perception out in the community that physiotherapists provide how in the care they provide short-term pain relief because I’m gonna saw this or a saw that we’re actually you know we’ve evolved a lot I think certainly in our research I often practice takes a bit longer to change but certainly the research work that we’ve been involved in highlights that hands-on therapies well they can provide pain relief in the short term they tend to be purely that it’s short term pain relief what we’re really interested in is providing a level of care or a certain type of care that actually empowers the person to self-manage their problem and actually reduce the reliance on us to provide care to them so in a sense we’re working as hard as we can to get people not to rely on their care which may seem like a a very bad business model but it’s actually a wonderful health model because it puts people in charge of their health isn’t confidence it gives them the tools to actually manage flare-ups if they get a pain Fleur gives them confidence to engage with movement and activity and to go to work even if they may have some pain because they not know they’re not doing harm to themselves and it also equips them when they can’t contact us that they have tools and they took it to actually cope with their pain in a better way so I think you know when we kind of see these different ways of looking at physiotherapy the idea that physiotherapy is about hands-on therapy and providing short-term pain relief we know from all the guidelines that it’s an option it’s not the care package it’s an option you can add that into your care package but it isn’t the care package and actually the care package is giving people a clear understanding of their pain maybe sure that you’re identifying anything seriously you can refer them through the doctor giving them strategies to manage their problem that often involves exercise that may involve relaxation it involves getting them back to living again and addressing other lifestyle factors such as sleep managing stress regular physical activity caring for how you eat those kinds of things that we know are very important in terms of your general health and both mental and physical and I think we’re dealing with a population at the moment who’s really fearful they go into enormous stress often they’re located to homes and I really feel for people in our community who maybe have helped underlying health issues or in the ADA older age group who are feeling quite isolated in their homes to us telehealth is an amazing opportunity to support those people in that community yeah absolutely and by the sounds of it not just our local community but you know wider than that across the country because the world absolutely yeah and you sort of mentioned it being a bad business model what I know you know from my perspective is if I sign and they help me get better and kind of taught me how I can better and get better and stay better you know I’d probably tell everyone about it or if someone asks me you know pain I’d kind of share that news as well it’s tongue-in-cheek the bad business book was actually good care of human beings is a wonderful business model and the best care you can give someone it’s the best way then you can have people coming back to see you not the same people but the friends and the family and you know the people in the neighborhood that’s the best model of care so what sort of advice would you give to you know people in the community that are a bit stuck at the moment and are dealing with you know uncertain circumstances well yeah look I’m head I had my day today of doing telehealth sessions I’ve had people of all ages actually I’ve had a young young chap I’ve had a number of older people all of them I think would be feeling a bit you know uncertain had people who came out of the gym anymore so they having to reframe what exercise looks for them because that’s been their mode of exercise so we’ve had opportunities discuss what other kinds of exercise they can do build up a program for them that they can do it that kind of it’s good for their health I’ve had another chap who’s had a pain exacerbation and so I’ve been able to give him simple strategies in his own around managing of reactivating relaxing is part of getting moving again building his confidence so he can get back into activity I have other people who are over 70 who are really constricted to their homes I wonder when I build up an exercise program for them that they can do in their living room then both dresses issues around their mobility and their strength their balance as well as their fitness so you know we can be really creative around what we do with almost no equipment at all just using body weight in a chair and and and using imagination using music you know dance there’s so many ways in which you can build movement back into people’s lives in a creative way that is linked to their goals and the things they love but also is good for their health yeah great awesome and so if people you know wanted to find out more or set up a consultation with someone like yourself or or anyone else what what should they do it’s a great question here but I think probably the the thing I would ask furthest is what can you what can can you provide me through telehealth and I think that taps into fundamentally what people’s under help people understand pain so if you’re hearing that someone’s saying look we can listen to your story and we can we can assist you we can set up we can map out you link to you goals we can build strategies to get you back in control your life or doing the stuff you love and building confidence and give you resources that can help you understand that how paint works better then that’s probably the consultation you want to go for if you’re going for a consultation and the angle is more well we can teach you how to self massage and don’t need on providing your own basic therapies to me that doesn’t align so well with evidence so I’d be asking some questions first before you set up that consultation around what that might look for me and what what that model work here would look like because I think that’s the fundamental question the way it deliberate something else that what the contents of delivery is the key yeah sure awesome is there anything else that you wanted to talk to the public about telehealth or looks happening oh yeah I think this I think we’ve had so much change in that community within a very short period of time we’ve been talking about doing telehealth for years now but we really haven’t had the time to do it we’ve been forced to do it so that’s something that we’ve done literally what was going to be a two-year plan we’ve done in a wench so I think what a crisis like this does is it forces us to change and adapts the other thing that I think is really important is that um a lot of our community will be feeling abandoned at the moment they might have been a wait list for a knee replacement or a hip replacement or an arthroscope or a tendon repair or other forms of surgery might be for the spinal or other body parts and I think that one message that I would give to that aspect about community is that there is so much that high-quality physiotherapy care can offer those people and we’ve seen it in the glaad program with you know people who thought who could well each had and they have a crowded limo activity managing weights can be a significant pain reduction reduce their medication get themselves active and we’ve seen it with the number of trials now around the co t approach that without hands-on therapy you can coach someone to understand their pain get back to living again and that can have huge benefits in terms of reducing their levels of pain disability so these there are lots of opportunities that I think that can come from this crisis where people may feel like they’re being denied one level here that’s more into like surgical interventions but actually there’s a whole other level of care they can access and we know now that the government has agreed to support telehealth for chronic musculoskeletal disorders from medicare rebates and we know the health funds are also coming on board to support that so actually is a profession I think they have an amazing opportunity to reach a group of people we may not have rest otherwise because they’re looking for a different kind of care that they haven’t been out of access the cool thing is we’re not limited by geography now that we can provide this level of care to a wider community to geographical areas the people who may not have been ever get access to us through transportation barriers etc yeah absolutely and I think what you’re sort of saying about people having a different option I like some a study that was done out of undergrad program and gain mark where they put people up a wait list for people that were going to have knee replacements and they gave them an exercise in education and a weight loss sort of program which is don’t you know that can be done through telehealth and a year your follow-up seventy-five percent didn’t actually end up having a knee replacement because they got to a stage where they they improved so much from the the education side two years it was 66 percent that still hadn’t had the knee replacement yeah and highlights a huge opportunity for people to have you know alternative care absolutely and look I had a guy and just last week who we saw I saw it the first time an evening table he needs total replacement I’ve set him up with the program but is his surgery was canceled and he came in really just as a checkout review but this guy is gonna do just fine he’s fearful he’s got he’s protected we throw up the program I’m reviewing his program later this week he’s just avoided what I would say would be unnecessary surgery and I think what we do know at the moment is there’s a lot of unnecessary elective surgery that’s not acute surgery like fractures and and and and you know acute medical problems but a lot of people are being scanned and get told on the basis of you know a rotator cuff tear or some some joint changes that they need joint replacement and we know be it knee hip shoulder that or rotator cuff tears or lame or test the him for example meniscal tears the knee that they could physiotherapy kid and involves educating people and pairing them giving the back of control of the health and have a massive benefit for those people both in terms of symptomatic reduction but also just getting them back to living again and functioning and caring for their general health and I think those are the messages that we want this is not a fix it’s not a cure but actually surgery isn’t either but but it’s actually a way in which we can support people who would feel maybe abandon yeah yeah absolutely a huge opportunity for us or to sort of work together yeah the best care fit one out there are you mentioned save table for now obviously you’re a professor at Curtin University doing research there but for the people that don’t know what’s EFT is can you briefly discuss that look it’s it’s it’s called cognitive functional therapy and so it’s an approach of management for people with disabling muscle is through problems been a number of studies that have looked at the application and this approach for the lower back but we’re also applying this to other body regions like the hip and the knee and essentially the the basis is approach is similar to the things that we talked about now it’s around understanding people stories understanding their beliefs it fears their worries and concerns about their pain we exploring how they use their body in relation to the pain and often what we see when a person has pain for a period of time tissue becomes very sensitive they’ve become very protective and guard their body region they start start not using it normally and I can set up a look will you get ongoing sensitivity protective guarding disused disability into stress so the cognitive functional approach is to get people to understand the understan pain gradually get them back to restoring their levels of function kind of taken the protective like the hand break of the system by not protecting the body and that takes time it’s a graduated process of restoration of movement learning to relax the body getting back strength and mobility and function and confidence back to the body to get back to living it in and that takes about a three-month process of gradually coaching someone through that journey and can take anywhere between five and what could be even as long as four for some of our really motivated at up to ten sessions over a three-month period and look there are a number of studies now looking at people with disabling back pain demonstrating larger benefits in terms of pain reduction and but particularly improvements in function certainly up to six months and functional improvements out to a number of years and I think what it highlights is that coaching people for better health is a really great way of caring for people rather than creating a dependence on them to come back and see us again and again yeah sure awesome thanks so much for your time paid right oh thank you