{"id":9858,"date":"2021-07-25T07:00:53","date_gmt":"2021-07-25T06:00:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=9858"},"modified":"2021-07-26T15:46:44","modified_gmt":"2021-07-26T14:46:44","slug":"group-telerehabilitation-in-the-covid-19-era-a-new-approach","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2021\/07\/25\/group-telerehabilitation-in-the-covid-19-era-a-new-approach\/","title":{"rendered":"Group Telerehabilitation in the COVID-19 Era: a new Approach"},"content":{"rendered":"

Person-centred experience for telerehabilitation following Anterior Cruciate Ligament Reconstruction – part of the Association of Chartered Physiotherapists in Sports and Exercise Medicine’s blog series<\/em><\/strong><\/p>\n

The rationale for this project is to co-design (1)<\/sup> alternative ways of engaging with patients using telehealth frameworks (2)<\/sup><\/a> and provide person-centred rehabilitation post-surgical reconstruction for anterior cruciate ligament injury (ACL-R).<\/p>\n

Rationale for \u2018Group\u2019 Telerehabilitation Following Anterior Cruciate Ligament Reconstruction<\/u><\/strong><\/p>\n

Anterior Cruciate Ligament Reconstruction (ACL-R) surgery is a common procedure. (3)<\/sup><\/a>\u00a0 However, despite around 80% of ACL-R patients returning to some kind of sporting activities, only 65% return to their pre-injury level and 55% to competitive sport (4)<\/sup><\/a>.\u00a0 Inadequate rehabilitation has been cited alongside poor preparation for return to sport as factors which could limit sporting performance and predispose to re-injury (5)<\/sup><\/a> (6)<\/sup><\/a> (7)<\/sup><\/a> .\u00a0 A systematic review with meta-analysis by Wiggins et al<\/em>. (2016) estimated approximately 20% of those returning to sport following ACL-R experience a second ACL injury (8)<\/sup><\/a>.\u00a0 With a heterogeneous selection of ACL-R rehabilitation protocols available online (9)<\/sup><\/a> and within the literature, (10)<\/sup><\/a> in conjunction with the disruption to physiotherapy rehabilitation services during the COVID-19 pandemic, it could be argued that a perfect storm has been created for poor provision for those rehabilitating from ACL-R.\u00a0 This could be exacerbated as orthopaedic services resume without the follow through capacity to adequately rehabilitate post-surgery.<\/p>\n

Co-design of Novel Telerehabilitation Products and Processes Following ACL-R<\/u><\/strong><\/p>\n

Use of co-design in healthcare environments is relatively new (11)<\/sup><\/a> with no standard model for doing so being applied.\u00a0 Indeed, it is noted by Brocklehurst et al<\/em>. (2018) that many different methodologies could be used (12)<\/sup><\/a> with co-design involving collaborative and evolving processes, with ownership and a practical focus being key according to some (13)<\/sup><\/a>.\u00a0 With involvement of stakeholders to broaden the range of available ideas and gain their views being central in underpinning patient-centred rehabilitation (14)<\/sup><\/a> (15)<\/sup><\/a> post ACL-R, it was deemed prudent to harvest patients\u2019 views in constructing the novel telerehabilitation products and processes.\u00a0 This was initially done via an on-line survey, link below:<\/p>\n

https:\/\/forms.office.com\/Pages\/ResponsePage.aspx?id=veDvEDCgykuAnLXmdF5JmmxuPlnAx_pKibiujACK1XdUQTZGUk5aV1FaQzhUQUUzUUhESDNQTElYTS4u<\/a><\/p>\n

On-line video resources with pertinent points of the rehabilitation exercises are currently being produced, as this was identified from survey results by patients as an important part of their ACL-R rehabilitation, particularly during the ongoing COVID-19 pandemic with a continuing reduced capacity for face-to-face physiotherapist engagement.<\/p>\n

As this pilot for \u2018Group\u2019 telerehabilitation post ACL-R is rolled out, support for patients is provided via video conferencing using Near Me Video facilities within NHS settings.\u00a0 This allows appropriate regressions or progressions to be made for the patient within an evidence based post ACL-R protocol which both the physiotherapist and patient have access too.\u00a0 As part of the monitoring the Knee Injury and Osteoarthritis Outcome Score (KOOS)<\/a> is known to have validity and reliability in measuring the functional status and quality of life for patients following ACL-R and is valid for research purpose with competitive athletes (16)<\/sup><\/a>.<\/p>\n