Going online for physical therapy

Changi General Hospital principal physiotherapist Rachelle Lim during a tele-rehabilitation session. PHOTO: CHANGI GENERAL HOSPITAL

SINGAPORE - Student Sophia Wong underwent reconstruction surgery at Khoo Teck Puat Hospital (KTPH) in January for a knee ligament tear and had to go for physiotherapy after the operation.

Her weekly sessions at the hospital were moved online during the circuit breaker beginning April 7 due to the coronavirus pandemic. She met the physiotherapist on video-conferencing platform Zoom, fortnightly at first, and every three to four weeks now.

The 17-year-old said the online sessions have encouraged her to monitor her progress and bring up concerns with the physiotherapist.

"Occasionally, when I'm unsure if I'm doing the exercises correctly, I'll ask the physiotherapist. With guided advice, my concerns are easily resolved," she said.

Hospitals have increased tele-rehabilitation services due to current safe distancing measures.

This allows therapists to monitor the patients' progress virtually, and also provides rehabilitation services such as physiotherapy, speech therapy and occupational therapy through online platforms.

Mr Jonathan Loh, a senior physiotherapist at KTPH Rehabilitation Services, said its tele-consultation service is usually offered to patients with stable medical conditions where exercise therapy is the main form of treatment and also to those who are on track with recovery.

Patients who receive rehabilitation virtually only need a mobile device with Internet access.

They are encouraged to use tablets or laptops as the larger screen gives a better view of exercises demonstrated by therapists. They are also advised on the equipment to use, usually household items or weights.

Mr Jonathan Loh, a senior physiotherapist at KTPH Rehabilitation Services, demonstrating a wrist and finger stretching exercise. PHOTO: KHOO TECK PUAT HOSPITAL

The sessions can be done with patients on their own or with a family member or caregiver by their side.

Mr Loh said therapists at KTPH have been holding a combination of physical sessions and tele-consultations since the circuit breaker was lifted in June.

"New cases are seen face-to-face to allow the rehab team to do a comprehensive initial assessment and formulate a management plan. Patients are offered tele-consultations for subsequent sessions if their conditions are deemed stable and suitable," he said.

Yishun Health, which comprises KTPH and Yishun Community Hospital, has held about 220 tele-consultations in physiotherapy, occupational therapy and speech therapy since May.

Alexandra Hospital's Rehabilitation Services' tele-rehab cases have increased from four in April to an average of 20 new cases monthly. The services cover physiotherapy, occupational therapy, speech therapy and podiatry reviews.

Ms Beryl Wong, principal physiotherapist at Alexandra Hospital, said that apart from patients saving time and the transport cost of travelling to the hospital, tele-rehab is beneficial as they do therapy in the comfort of their home and do not risk contracting Covid-19.

Ms Pha Hui Jun, 31, a senior executive in a tertiary institution, has been undergoing physiotherapy at the hospital since last year. She had her first tele-rehab session this month, and her therapy comprises neck and shoulder exercises to treat recurring migraines.

She said she showed the therapist via Zoom the area where she does her workouts at home.

The therapist noticed the back support of her chair, which she uses for over eight hours when working at home, was too low.

Ms Pha said: "She advised me to use a pillow for better support. If not for the video consultation, I wouldn't have thought of showing her my chair."

However, there are downsides that come with tele-rehab.

Ms Wong said: "Physiotherapists cannot correct a patient's posture in person and there is a lack of face-to-face interaction. Because of this, patients may misinterpret the advice given and may not be able to replicate or perform the exercises accurately without the therapist's physical assistance."

Tan Ee Leng, a senior physiotherapist at Alexandra Hospital during a virtual consult session with a patient. PHOTO: ALEXANDRA HOSPITAL

With tele-rehab, physiotherapists are also unable to test a patient's muscle strength using resistance tests, said Mr Loh. To get around this, a patient's strength is tested through repeated sit-to-stand tasks.

Patients are asked to help physiotherapists take measurements, for example, girth measurements of thigh muscles, using a tape measure.

Speech therapist Christine Chua from Tan Tock Seng Hospital (TTSH) said there are limitations on activities that require speech therapists to provide tactile cues or use specialised equipment that patients do not own.

Speech therapists conducting tele-rehab have to observe patients closely for the slightest signs of difficulty when assessing their ability to swallow when eating or drinking.

"In this case, corroborated information provided by patients and their caregivers is important," said Ms Chua.

About 15 to 20 per cent of outpatient speech therapy sessions at TTSH are currently conducted via tele-rehab.

Programmer Peter Lee finds online speech therapy sessions a "comfortable" experience. The 60-year-old, whose speech is impaired due to Parkinson's disease, had his first tele-rehab session in March.

He said: "Doing voice control practice at home eliminates the worry of going to the hospital and the fear of contracting Covid-19. And my wife doesn't need to deplete her annual leave to take me there. It's convenient."

Therapists at Changi General Hospital's (CGH) Rehabilitative Services have held an average of 120 tele-rehab sessions monthly since June. Senior physiotherapist Wong Shi Hui said one of the challenges for patients is not having adequate space for therapy sessions and having to position themselves at a distance away from the camera so they can be seen fully.

However, retiree Chong Mah Lay, 75, who has had four tele-rehab sessions in physiotherapy with CGH, said she found it very convenient.

"My children taught me how to use Zoom and I have not had any challenges as the physiotherapist's instructions and demonstrations are very clear," said Madam Chong.

Dr Effie Chew, who heads Rehabilitation Medicine at Alexandra Hospital, said: "Covid-19 has accelerated the adoption of tele-rehabilitation. While Covid-19 is devastating in its impact and effect in so many areas of healthcare delivery, it also presents opportunities for us to rethink and reset a new normal."

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