After having surgery for a knee fracture, Inna Kozachenko needed rehabilitation to rebuild her strength and flexibility to help her walk again.
“I could not bend my knee or lift my leg,” says Inna. “I definitely needed help.”
Inna worked with physiotherapist Jean Yee at St. John’s Rehab, attending appointments with the help of virtual care.
“Initially due to COVID-19, I was not able to see patients at all due to the closure of the out-patient department,” says Jean. “Although face-to-face physiotherapy treatments are the ideal way to provide care, we have adapted our approach to deliver the best care we can virtually and maintain strong communication with patients to comprehensively assess and address their complaints and concerns.”
How does virtual care work?
As physical distancing is a key factor in limiting the spread of COVID-19 during the pandemic, health-care providers have continued with patient appointments and treatment through virtual care. Sunnybrook and other health-care facilities have been using virtual care through the Ontario Telemedicine Network for many years. This allows patients to remain at home but still connect with their health-care teams on-line and over the phone for an appointment to discuss any health concerns or continue treatment.
“A patient may need assistance with setting up the computer technology,” says Dr. Sara Mitchell, a virtual care co-lead and neurologist. “In some cases, family and friends can help provide further clarity to both patient and doctor by attending the appointment in person safely, if they are in the same household or social bubble as the patient, or by attending virtually and joining with a special appointment link.”
“When a patient is preparing for a virtual appointment, it’s helpful for the patient to set up in a private, quiet and well-lit room of the house,” says Dr. Philip Lam, virtual care co-lead and infectious disease physician. “This will help improve the ability for the patient and health-care provider to see and hear one another. It’s also helpful for the patient to have eyeglasses, hearing aids or walking aids close by during the appointment so those assistive tools are right there as soon as they’re needed.”
What happens during a virtual physiotherapy appointment?
“When I first heard my physiotherapy was going to move online, I was surprised,” says Inna, who was used to having hands-on care. But the 61-year-old says using the computer for the virtual consultations has been helpful in her recovery. “With the right step-by-step instructions, it’s absolutely easy. I wouldn’t have progressed as much without virtual care.”
“Various examinations are performed through observations via computer cameras,” explains Jean. “This can include observing a patient’s movement, joint mobility, how they walk or gait pattern, and even skin condition. From the history and examination, and together with the patient, we determine the functional goal we want to achieve.”
Physiotherapists also use the computer to teach their patients how to do the exercises that can help improve their conditions, as well as continue to design personalized exercise programs for patients.
“Jean can see how I am exercising, what I am doing, and gives me instruction and advice on what to do, and how to do it better,” says Inna.
Some of the hands-on treatment typically offered, such as massage and hydrotherapy, are not currently possible because of the pandemic, but Jean adds, treatment can go beyond the physical. “Through virtual care, physiotherapists are able to determine from the examination if patients will benefit from care outside of physiotherapy services, such as social work or psychology, and advise the patient accordingly.”
Continuing health care at home
Inna says she feels lucky to maintain the connection with Jean from her own home. Eventually, she learned to walk without pain.
“It was not easy, believe me. I would limp at lot,” she says.
But with Jean’s help, Inna learned to distribute her weight and walk correctly. “Slowly, but correctly. Step by step.”
“The patients’ responses to virtual care have been very positive,” says Jean. “They know that there is someone they can consult with regarding their concerns about their recovery. They also feel more confident that their condition will improve with the appropriate guidance and exercises provided by the physiotherapist.”
“Everything is so good because I can see her, I can hear her, and I can use this instruction that is personalized for me,” Inna says smiling.
Advice for patients attending virtual physiotherapy appointments
“The therapist must have the consent of the patient to participate in virtual care. Patient privacy is also important,” explains Jean. “For the actual virtual appointment, both clinicians and patients will require a stable internet connection, as well as a camera and microphone on their computer, tablet or phone.”
“It’s important and helpful for patients and clinicians to provide clear verbal communication and demonstration. At times, it can be beneficial to have someone else present with the patient for safety or to help with translation, if needed,” says Jean.
“If you have the chance to have virtual treatment, you should use it,” says Inna. “This is a chance to have good results and have the professional, personalized advice to manage.”
Today, Inna can walk with a cane for 40 to 60 minutes, several times a day. “It’s not easy, a bit painful, but I’m on my way!”