Hands turn to telehealth

Lisa Copland, Occupational Therapist

Change is hard. It is even harder when you need to do it quickly, without the usual planning and evaluation of your practices. This is what we have dealt with during 2020 and now 2021. Shutdowns, physical distancing, and many government restrictions have forced us as occupational therapists to rethink how we provide our care to the most vulnerable.

Telehealth feels like it has been thrust upon us providers. You may feel like telehealth has little evidence, that the technology is clunky, the internet drops out, and privacy issues and poor computer literacy of clients make it difficult to provide best clinical outcomes. It is true that some components of our clinical practice are difficult, if not impossible, to provide via telehealth. Splinting, compression bandaging and objective measures such as strength and formal sensory assessment require a faceto-face review. A proportion of patients will continue to desire a traditional clinical model of service (Worboys et al., 2018).

What the research says

While the virtual environment has limitations in providing hand therapy care, it improves access for patients in under-serviced areas and can be efficient in terms of reducing costs, travel time, waiting room time, administrative costs, environmental pollution and energy consumption (Szekeres and Valdes, 2020).

Studies of burn wounds show that still digital images are a reliable way to assess wounds, to differentiate between different burn depths and to identify oedema, erythema and cellulitis (Wallace, 2004). Literature supports a range of motion assessments via telemedicine using smartphone technologies, demonstrating excellent agreement with conventional measurements for the shoulder, elbow, wrist and hand (Grandizio, Foster and Klena, 2020).

Occupational therapists can guide clients to make observations, palpations, complete muscle tests, and self-apply orthopaedic and neural tension tests. Direct comparison with a physical examination revealed high clinician agreement and correct diagnoses (Worboys et al., 2018). Research suggests greater improvements in grip and pinch strength for patients who completed treatment by a telemonitoring system, compared with those who completed self-directed practice at home (Worboys et al., 2018).

Additionally, the impact for clients should be considered. Many clients feel comfortable with telehealth and would prefer to use it if available. Many consider telehealth equal to a traditional model. High levels of consumer satisfaction with telehealth are a consistent finding in the literature (Worboys et al., 2018) It also allows improved access with reduction in travel, costs, child care and time away from school/work (Grandizio, Foster and Klena, 2020). Ultimately, if clients see it as a benefit to them, telehealth may reduce nonattendance and optimise therapy outcomes.

How to succeed

Healthcare costs are growing, with the potential to be unsustainable. Telehealth is an innovative strategy to address this. Implementation will be guided based on ongoing funding for providers and infrastructure at a national and local level. It will also be dependent on your willingness to change your ideas about how you provide your usual therapy. A virtual and face-to-face mix optimises efficiency, improves access to therapy, decreases costs, minimises exposure to virus transmission and optimises hand therapy outcomes (Szekeres and Valdes, 2020).

As occupational therapists we began our careers celebrating our creativity and ability to innovate and provide a holistic therapy program for our clients. Allowing clients to achieve their goals and perform their occupational roles is core to occupational therapy. Telehealth has the potential to enhance patient access to intensive management of hand injuries, helping to optimise patient outcomes (Worboys et al., 2018). Telehealth is one of the many ways that we can provide care that is a best fit for our clients.

About the author: Lisa Copland is an occupational therapist and certified hand therapist. She has worked across public and private settings and is now working in Queensland Health. Lisa is passionate about clinical outcomes that benefit all consumers, and led the telehealth project during Covid-19.

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