Title: Supporting Consultations in Remote Physiotherapy (SCiP): a mixed-methods study of physical examinations by video in NHS physiotherapy services
Funder: Department of Health and Social Care

Abstract: BACKGROUND The COVID-19 pandemic has led to a rapid scale-up of video consulting across the NHS. Video consultations are now being used in physiotherapy services to assess patients and how they move remotely. However, clinicians and patients are grappling with new ways of interacting, including how to conduct a physical examination. RESEARCH QUESTION How are physical examinations by video for physiotherapy successfully accomplished; and what is the role of intermediaries and technologies in supporting this? AIM To understand how physical examinations are conducted for physiotherapy services; and to produce guidance to support wider use in the NHS. METHODS Mixed-method study, combining video-recordings of up to 20 video consultations in physiotherapy services with interviews. We will seek diversity in clinical, social, ethnic and personal circumstances of patients, as well as health/digital literacy. Analysis will use established micro-analytic methods to understand how participants overcome challenges of interaction in remote physical examinations. TIMELINES FOR DELIVERY 12-month study, involving initial set-up (month 1-2) and three overlapping work packages: Case studies (2-6), collecting data On-going analysis (3-9), of video and interview data Dissemination & impact (8-12), co-designing guidance, informing spread and scale up of video consulting in wider NHS ANTICIPATED IMPACT AND DISSEMINATION We will: Develop evidence-based guidance, co-designed with clinicians and patients, to support video examinations in physiotherapy in the wider NHS; Link with DHCS, NHSE/I and other decision-makers to help shape evolving policy for video consultations; Write one academic paper on physical examinations in video physiotherapy for top tier medical informatics journal.

Lay abstract: BACKGROUND Video consultations using Skype and similar technologies are being rapidly introduced across the NHS. Physiotherapy services have significantly scaled up services to enable patients to access healtcare during the COVID-19 pandemic, with limited time to consider impact on clinical practice. AIM To understand how physical examinations are conducted for physiotherapy services; and to produce guidance that can support wider use in the NHS. METHODS We will video-record up to 20 video consultations in three physiotherapy services (orthopaedics, pain management, and neuromuscular). We will use established analytic techniques to understand how physical examinations are successfully completed over video, including how people talk, move their body and use technology. We will interview patients and clinicians who participate in these video consultations to understand their experiences. PATIENT AND PUBLIC INVOLVEMENT The research has been shaped in collaboration with the Patients Active in Research on Digital Health (PAIReD) group. Members have agreed to sit on the advisory group: ensuring patient voices are an integral part of service evaluation, shaping the design and conduct of the study, and helping to develop public dissemination. Working with a design company, we will involve patients and clinicians to review emerging findings and co-design guidance on examinations by video in physiotherapy. DISSEMINATION We plan tailored outputs for these audiences: Service users: illustrated guidance with practical advice on remote physical examinations; Clinical/support staff: guidance on how to do a remote physical examination; Policy makers: policy briefings and online resources; Researchers: journal article.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MUSCULOSKELETAL