COVID-19 – Doing Things Differently – HOPE Respiratory Service

HOPE Respiratory Service connect with patients online to continue their rehabilitation

Many health and wellbeing services were tasked with embracing alternative methods of working in mid-March when COVID-19 forced the country to go into lockdown. Whilst some restrictions have been lifted in recent weeks there are still reasons for concern, especially for people who are seeking or completing treatment for conditions they need continual support for that put them in a higher risk category for complications if they were to catch COVID-19.

As a result, Care Plus Group’s HOPE Respiratory Service has taken their practice online and set up a Remote Rehab programme via Zoom, ensuring they continue to deliver support to patients across the community, albeit in a virtual setting.

Irene Grainger, Senior Physiotherapist at HOPE Specialist Service, said: “We have tried to replicate our normal HOPE Respiratory Service framework as much as possible during the pandemic. Rather than saying “we can’t” over certain areas, we’ve tried to look from a “how can we” standpoint. This led us to develop and deliver a Remote Rehab programme to patients via Zoom whilst we’re unable to operate our normal face-to-face sessions.”

Irene added: “It’s a very different way of working and being on Zoom for most of the day can be exhausting. There’s an extra level of concentration needed to be spotting problems in a situation where non-verbal communication is so restricted.

“We have all had to move outside of our comfort zones and into a world of technology. We hadn’t heard of Zoom three months ago, but now we’re running our Remote Rehab sessions over the platform so it’s been a steep learning curve with getting ourselves up to speed and then trying to get our patients familiarised with the application in the early weeks.”

There were a few teething problems when it came to developing the plan around patients’ access to technology and their willingness to engage. The HOPE team spent a considerable amount of time contacting their patients and discussing the notion for them to join a Remote Rehab programme.

Irene said: “Our patients tended to fall into three categories; those who wanted to engage remotely and had the capability, those who wanted to but didn’t have the technology and those who had the technology but didn’t want to.

“For those that didn’t have the technology we worked with them to access it, and on occasion offered to provide smart technology on a temporary basis to enable access to the programme. For those that didn’t want to access in this way, we had some honest conversations about how long it may take for us to get back to actual rehab.  We signposted them to educational videos and websites or offered to send them general advice.

“We also started to think about things we could offer and keep social distancing which led to us trailing garden assessment and rehab. We continue to consider how we can best serve this population. Our actions really depended on a conversation with our patients to look at their presentation, their desires for the future, the risks associated with their choices, then enabling them to come to an informed decision about their future.”

Although patients have been keen to engage in the programme through technology there have been challenges finding the right environment in people’s homes to carry out the exercise component.

Irene said: “Some of our patients don’t have a large open area within their house, so space is at a premium and finding the right place for them to do their exercises can be quite a challenge – especially since a key component of our programme in Pulmonary Rehabilitation is getting people out of breath.

“We have to be vigilant of any health and safety risks whilst patients are carrying out their exercises. Some patients have oxygen cylinders so the tubing acts as a potential trip hazard and others have their cat or dog mooching around their feet, out of shot on our screens.”

“However, this is real life and we don’t want people just to exercise while we are there with them virtually, we want to make it part of their everyday life so doing it in their homes may help with this”, commented Pamela Hancock, Respiratory Lead for Care Plus Group.

Irene continued: “There are quite a lot of risks that we have to try and spot when working in this way. Even if we discuss all this with patients at the start of the session, it’s natural for them to forget about some of the issues, so we are finding things out as we go along each day.

“Then there are the other issues patients present us with. Although patients have been referred because of their lung condition they usually also have other musculoskeletal issues that often accompany lung conditions or have developed over time, for example back, shoulder or neck problems.

“Normally we would incorporate a physiotherapy assessment to enable treatment of these areas while people are following the programme. However we can’t do hands on assessments in the current climate which adds to the challenges we face.”

As with the majority of the HOPE Specialist Service programmes there are educational components attached, but due to a shortage of physiotherapists in our home team the team took the decision to record these elements as opposed to doing them “live” each session. As with so many services, the HOPE team were used to cover need created by the COVID pandemic and were “hands on” delivering care in a quickly developed post-COVID centre.

Our Team also includes Occupational Therapists and as always we worked as a team to meet the needs of the service and the patients. “Although we are a very integrated team this response by our clinicians has been truly remarkable” commented Pamela Hancock.

Irene explained: “We have a number of staff who would help in delivering our education talks. Our Physiotherapists, Occupational Therapists and Technical Instructors have been talking over their PowerPoint presentations as we would normally, but we’ve also recorded these via Zoom to be used again when deemed necessary. We’ve uploaded these to YouTube, but they can only be accessed by those who’ve been invited, rather than open access, as our talks are specifically for people with lung conditions and the information could be misunderstood or misapplied if out in the public domain.

“Some of our talks are still delivered “live”, but we decided to continue to record them so we can form a library of education as a resource that we can use in the future and perhaps could possibly be shared with other agencies, or support our colleagues also working with people with lung conditions if that were appropriate.”

Essential to the success of the HOPE Respiratory Service are the fantastic volunteers, the majority of whom have been through the programme and suffer from a chronic respiratory disease themselves.

Irene said: “Our Volunteer Buddies act as an extra pair of eyes and ears in rehabilitation sessions and also act as positive role models who can offer support and motivation for people going through what they have already been through. Our knowledge is theoretical, not experiential, so it’s extremely helpful to have our volunteers, who do have that experiential knowledge, to support us and help us deliver our programme.

“For example, after our educational talks we’ll ask our volunteers to tell some of their stories and experiences to help our patients. This is an aspect of delivery that fortunately hasn’t changed since turning to technology, with our volunteers still able to help us in this way over Zoom in the same way as before lockdown.

“This is another aspect I think we will keep offering, mentorship and advice via Zoom to those in need or wondering whether rehab is for them. The future offers a more blended version of rehab and the volunteers are helping us shape this model by encouraging us to offer a virtual drop in sessions for those on the resumed physical group program if they are unwell and offering to be virtual buddies even if they themselves cannot attend physically.”

Irene added: “Another volunteer, John, suggested that joining in a big group might be daunting so our assistants have been doing practice one- to-ones to get patients comfortable with the platform but as John says ‘’we can do that and have a chat about the program and help people feel comfortable and you guys can do other things”.

Pamela said: “This is the great thing about true co-production, we develop and deliver together and get peoples insight which hopefully means people feel more relaxed and feel it’s easier to truly engage.”

Although it’s still early days, as the team are only half way through their first Remote programme and haven’t carried out an evaluation yet, there have been some very encouraging feedback and stories from patients already.

Irene said: “We’ve had a gentleman who has slept through for the first time in over 20 years which we were amazed at. A lady with hip problems whose pain has now reduced and she is back to independent movement around her home; we’ve had two gents’ say they’ve particularly enjoyed engaging with people through the use of Zoom. We’ve had one patient who had been exercising with a member of staff and a volunteer, and he was getting on so well with our volunteer that they were chatting about meeting outside of rehab to have a Zoom chat.”

Whilst the virtual sessions have had a positive impact in the early weeks already, the team are considering continuing their Remote Rehab sessions alongside their normal face-to-face practice post COVID-19.

Irene said: “There is a population of people with lung conditions for which remote sessions are their first choice rehabilitation. Some people don’t feel comfortable in group settings so when the opportunity arises to be able to do home visits we will, but I suspect we will use a combination of home visits and remote visits.

“Using Remote Rehab will also enable us to see more patients during the working week and in less time. We still need to carry out assessments carefully to ensure each patient is directed to the most appropriate rehab for them – but I see a future for Remote Rehab at HOPE Respiratory Service, for sure.”

The innovative and award-winning, HOPE Specialist Service offer a number of options to help people who have been diagnosed with a chronic lung condition manage their condition and improve their day to day life. Each programme is made up of exercise and education tailored to suit the individuals’ needs and abilities, so no matter how little someone can do, the team can design a programme to help.

For more information about HOPE Specialist Service or to contact the team please visit our website on https://www.careplusgroup.org/services/hope-specialist-service

 

Remote rehab group shot

 

Another group of patients ready for their remote session

 

Patient going through a seated breathing control exercise

 

Patient performing walking practice in the garden whilst pushing and pulling a trolley

 

Patient making the bed during their rehab session

 

Online session with one of the teams physios and volunteers

 

Patient going through their breathing control exercise on the stairs

 

Resistance band exercises

 

Timed air punches exercise
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