Development and Evaluation of a Training Package to support the Remote Assessment and Management of People with Movement Impairment and Disability

Many people experience physical disabilities throughout their life, requiring advice and management from clinicians such as physiotherapists. Usually a hands-on detailed movement assessment is taken to help formulate a plan to deal with each individual's needs. For most this face-to-face approach has not been possible during the Covid crisis, and this is likely to continue for some time with social distancing, particularly in older people and those with health issues. In response to the crisis clinicians have found new ways of working. They have used telephone & web-based consultations (known as telerehabilitation) to help people continue to rehabilitate at home. This approach, however, has many challenges when assessing people with movement disabilities, such as those experienced by people recovering from Covid-19, with long term neurological conditions, arthritis or diabetes. For example there are risks associated with assessing balance and mobility in frail older persons at risk of falls. Yet this information is essential to create a plan to ensure recovery occurs as quickly and fully as possible. Unfortunately relevant guidance and training for NHS/Social care staff about this is extremely limited, relying mainly on experience gained on the job. No specific guidance is in place to ensure telerehabilitation is delivered effectively and equitably for people with physical disabilities. We will work closely with NHS/Social care staff to quickly develop an assessment toolkit and training to provide them with practical guidance to increase their skills and confidence. This is important now & for the future.

The problem:
Physical disabilities are common throughout life. Usually, hands-on detailed movement assessment results in a targeted rehabilitation plan, with ongoing evaluation required as needs change. During Covid-19, many people, of all ages, have received no rehabilitation, and rehabilitation need is escalating with recovering Covid-19 patients; creating a "tsunami of rehabilitation need". In response, clinicians are rapidly adapting and creating telerehabilitation solutions to manage caseloads and prioritise those at risk of deterioration, with little specific guidance, training or support. Professional bodies and clinical networks highlight the marked variations in approaches used, expressing concerns about potential inequity and inefficiency. Our rapid literature review underlines this problem, citing lack of specific guidance/training as barriers to effective telerehabilitation implementation. This has immediate and long-term relevance given the "new-norm".

Research aim:
Develop a Toolkit & Training package for the current/future workforce, wherein telerehabilitation will be integral to rehabilitation assessment and management.

Study Design:
Knowledge to Action Framework, methodology commonly used in implementation science. Key steps include: (i) literature review to inform guidance/provide examples of best practice; (ii) national online survey to identify clinicians' needs, (iii) production and evaluation of the Toolkit through iterative cycles of data collection, evaluation and refinement (initially in the SouthWest); (iv) national roll-out/evaluation, (v) production of final training package for use within clinical/educational arenas.

Study outputs:
Practical guidance, process pathways and training to optimise the confidence and competence of clinicians to effectively implement telerehabilitation in people recovering from Covid-19 and those with physical disability from across the lifespan.