On the 16th of March 2020, I started my secondment post in Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), however, due to COVID-19, this also marked the last day patients were attending appointments in our clinic.
I felt like the personification of a chocolate teapot: minimal experience in the field, and a limited chance to engage with patients. Following a month of adjusting to this new normal we began searching for ways to get back in contact with our patients. These patients included antenatal ladies with pelvic girdle pain, who were requesting advice over the phone. A common theme which arose throughout our conversations was the conflict patients had experienced about contacting us. Many patients confessed to feeling guilty about reaching out at a time of great pressure for the NHS, but felt desperate to call due to unbearable pain. As I am sure most, if not all of you reading this will agree, this is not something we wanted our patients to be agonising over. We are the NHS; here 24/7, 365 days a year, even now. We felt helpless and at a loss as to how we might help our patients, that was, until we heard about NHS Near Me (provided through the Attend Anywhere platform).
As a service, we began attending webinars regarding the platform for communication, Near Me. Immediately, mainly due to their age range (antenatal and postnatal patients) and their assumed technical ability, we felt a large number of our patients in POGP would benefit greatly from virtual clinics. We loved the idea of video calling, recognising the opportunity to help the large number of women who were calling and asking for advice on their pain. The ability to give these ladies the added reassurance of seeing someone, if not physically, but virtually was something we felt we could not ignore.
After numerous discussions across the POGP physiotherapy services in GGC, we agreed the benefits of trying this far exceeded the cons of failing. With this newfound motivation we began implementing our new normal for the time being.
After discussions with the team leads, we filled in a few forms on Staffnet which got the ball rolling. We received the equipment we needed relatively quickly, including webcams and monitors, and then completed a practice run with staff in the department. The practice run was a success, so we decided to trial it with a patient. Out of the frying pan and into the fire.
Our first virtual consultation was with an antenatal patient who was experiencing pelvic girdle pain. We had previously been in contact with the patient and given her lots of advice over the phone. Despite following our guidance, she was not finding any relief, and at this point we were at a loss of how else to help her. However, in comes Near Me. Around 10 minutes into the video call, the patient’s child came into the camera field. We then witnessed the patient sit down on the floor with her legs bent underneath and to the side of her, a compromised seating position which we had advised against numerous times due to the uneven load through her pelvis. I asked if this was a common seated position for her, to which she responded it was. After explaining the negative implications of this position, due to her changes in ligament laxity during pregnancy, she seemed to understand and admitted she hadn’t realised this was the kind of compromised seating position we had previously been advising against. This virtual consultation was extremely useful, as without it, we would never have known the ongoing cause of her pain. Small discoveries such as confused facial expressions during explanations of exercises, observations of diastasis of the rectus abdominis muscle separation (DRAMS) and as mentioned above, correcting posture and positioning, have all been invaluable to our practice over the last week.
A further aspect of our service we would normally conduct (or at least I have been told, remember, I’m a chocolate teapot at the moment) are antenatal classes to help with all aspects of pregnancy, labour and aftercare. This group session is usually brilliant at helping “mums to be” ask any questions they have, pick up valuable advice, and also socialise with other women in similar stages of pregnancies. Many of these women swap numbers and become friends throughout. Starting this group session again is something we are desperate to do. Unfortunately, due to a number of issues, Near Me is currently not recommended for group use. However, we performed a mock group session with staff which went surprisingly smoothly. We had two members of staff pretend to be patients and two clinician accounts, attempting to replicate an MDT approach. We lost sound on 2-3 occasions but found refreshing the screen rectified most issues. The point of this blog post is not to promote Near Me as “better than a physical consultation”, but it is an attempt to showcase how it can support service delivery and provide convenience to populations. It will also not be suitable for all patient groups, but in our service’s experience so far, it has the potential to be far superior to a telephone call for the patients we have selected. So, what’s the harm in trying it?
Lauren Ball, Physiotherapist @LaurenBPhysio