Just Phone It In!
A piece of research came out in the British Medical Journal at the end of last month regarding tele-physio. I've been a vocal critic of this practice "development" in this blog and to anyone who will listen. This is an important piece of research. If American PTs are inclined to brush it off as some silly NHS protocol, they'd be wise to contemplate whether or not managed care companies might pay close attention to it!
This is not a bad piece of research, but there are some areas that I think need addressing. The investigators used a large number of participants, but not ethnically diverse with more than 95 percent being Caucasian. The patients allocated to tele-physio were "invited" to call back after the initial telephonic consultation. No mention is made of how many failed to call back. Is it being assumed that they were fully managed with the one call?
The group allocated to tele-physio had 53 percent progress to some face-to-face intervention, with 43 percent being managed by telephone only. These two subgroups are lumped together in the analysis, when in truth, they are deserving of separate analysis! I would really like to see how these two subgroups compared to each other in addition to how the combination compared to "usual treatment."
There are also issues with the timeframe of measurements. If the initial follow-up was at six weeks post-referral, but some people still hadn't seen a physio at that point, then how can one measure impact? Yes, there's a problem with access to physio in the UK, but I don't believe this study truly supports tele-physio as a solution.
I do credit the investigators with a robust discussion on the strengths and limitations of the study. I can see a benefit to a telephonic triage prior to face-to-face interventions that could shorten wait times and initiate action sooner than is current practice. I can see this approach benefiting more rural settings where access is limited. I can't yet see the evidence for this becoming mainstream practice.
Lastly, having seen this practice in action in England, I take issue with practical applications. The study used senior physios to perform telephonic interventions. In practice I have seen Band 5, new graduates in the role who lack sufficient experience to ensure patient safety. I also question their investigation into adverse events (none?). I personally know of three people who performed a home exercise program that was mailed to them after telephonic consultation. All three performed their exercises incorrectly and two wound up aggravating their presenting conditions.
What are your reactions?