Before the pandemic I could not imagine the possibility of conducting telerehabilitation. Now I am never going to make that mistake again and say that something is impossible until I try it – we talk about online physiotherapy with Agnieszka Stępień, Doctor of Philosophy in PE Studies.
Agnieszka Stępień, Doctor of Philosophy in PE Studies – President of the Polish Physiotherapy Association in the years 2009-2017. As a representative of the Association, she actively cooperates with patient organizations. Member of the National Board of Rare Diseases Program to the Minister of Health (2016- 2017), Social Sports Board to the Minister of Sports (2018-2019) and Workgroup for Diagnostics and Conservative Treatment in the course of Idiopathic Scoliosis which is a part of the PAN Committee on Rehabilitation, Physical Culture and Social Integration. Member of the Research Committee International PNF Association. Founder of the Orthos Center of Functional Rehabilitation.
Aleksandra Mróz: The term “telerehabilitation” has made a staggering career among medical professionals over the last two months. You have decided to begin working like this with children. Does such a form of therapy really make sense?
Agnieszka Stępień: It certainly does. After six weeks of consulting patients online I can tell it is definitely a much better solution than complete lack of physiotherapy. Both us, physiotherapists, and our patients obviously used to have a strong conviction that physiotherapy can only happen through direct physical contact, through touch. But the last experiences have proven us wrong and showed that such a help can also be delivered from a distance. My estimation is that telerehabilitation allows us to complete even as much as 60% of work that we would normally perform in our office. And these are some significant numbers, considering the crisis situation that we are currently in.
Are all physiotherapists ready to successfully provide online therapy?
I feel that young physiotherapists with little work experience might have the biggest difficulties with telerehabilitation, especially if they deal with patients who experience pain. Since patients often require detailed functional diagnostics, young physiotherapists might find it difficult to properly identify the problem using only posture evaluation and patient’s medical history.
Can an experienced physiotherapist help patients who experience pain without actually touching them?
Such professionals are able to gather basic information and provide essential recommendations during a video call, possibly with the help of third parties. Over the past few weeks, I have had several video consultations regarding back pain in teenage patients. And I was able to help a patient by evaluating his posture, taking medical history and directing the hands of his or her caretaker. There are specific exercises which can improve postural abnormalities in young people. One of my patients was a 10-year-old girl who reported pain in the thoracolumbar spine. By providing instructions, I used the hands of her mother to perform soft tissue manual therapy intervention “through the computer screen”. Two days after the consultation, the patient reported significant improvement in her overall condition. It is worth noting that consulting patients who experience pain requires extensive knowledge and humbleness, as pain can also be a symptom of other diseases which require different therapeutic interventions.
Do you also provide online physiotherapy for patients with more serious conditions?
I have a few patients in critical conditions, including several children who are mechanically ventilated. So far, their parents have used specialist intensive care and provided them with 3 to 4 sessions of physiotherapy per week. Now they are left all alone. Moreover, the health condition of their children indicated taking maximum precautions to minimize the risk of COVID-19 infection. Needless to say that it meant isolating the family. The best solution for such patients is therefore video consultations.
How does your online work with such patients look like?
It turned out that the majority of parents know only a few simple exercises which their child should perform, e.g. stretching. More complex rehabilitation interventions were provided by physiotherapists in clinics. Parents were not familiar with numerous exercises which are crucial for maintaining the patient’s condition or improving functioning. They did not know how to direct their children in order to teach them to turn, sit or stand.
And that is when technology comes to the rescue. We prepare video lessons and work with parents, teaching them how to perform specific exercises with their children. Every lesson has a concrete topic, for example improving head control. I instruct parents as they perform five or six different exercises of gradually increasing difficulty. Another lesson is about the muscles of the trunk, another about scoliosis or verticalization. It is very important that parents receive detailed instructions for repeating these exercises at home.
And how do young patients behave when they have to work at home?
I have to admit that, thanks to a modified form of contact, I have gained more knowledge about my young patients. I already know all of their toys and am familiar with dress collections which were so eagerly presented by girls. I once had online class with a boy who showed me his 30 toy locomotives and named every single one of them. Of course we used them during exercise. I also have my own toys: a bunny, which usually claps when children correctly perform an exercise and a bear which demonstrates specific movements, so that children can easily copy them. This is a very attractive form of contact, especially for the youngest children. Young patients feel at ease and safe in their home environment, they are very willing to cooperate. They eagerly present me their small world, which I normally do not see in the office, since we are focused primarily on completing the consultation, taking measurements, performing exercises.
As physiotherapeutic services are being “unfreezed”, you are reopening your facility for the patients who need such help the most. But what will be the future of video consultations?
I will naturally be forced to limit the number of online consultations as I get back to work in my office. This is particularly difficult, since I have already become good friends with many of my patients. Their parents also inform me that they would like to continue our work. I am talking about patients from all regions of Poland, who usually have limited opportunities of coming to Warsaw for therapeutic sessions. I have also met a few families from Italy, France, Germany, Denmark and Ukraine.
Before the coronavirus outbreak I could not even imagine the possibility of conducting telerehabilitation and have never approached such challenges. And never again will I say that something is impossible before actually trying it. I now realize how many valuable recommendations can be provided online, even for patients in critical conditions. I have completely changed my attitude towards online work with patients over the past six weeks. And it seems to me that this is a very important thing that we have learned during the pandemic. Our permanent offer will feature online consultations from now on.
AM: Thank you for this conversation.