IMPACT Trial – qualitative research findings

Our qualitative research⁴ showed video consultations were acceptable to both patients and physiotherapists. Patient convenience, flexibility, empowerment to self-manage and positive therapeutic relationships were emphasised by both patients and physiotherapists. Patients were very satisfied with the care they received and believed it was effective for them personally. These findings indicate most patients are willing to engage in video consultations for chronic musculoskeletal conditions.

Summary of themes arising from the qualitative research:

Technology – easy to use, variable quality, set-up assistance from research team was helpful

Patient convenience – time-efficient, flexible, increased access to care

Empowerment to self-manage – facilitated by home environment and therapists focusing on effective treatment

Positive therapeutic relationships – personal undivided attention from therapists, supportive friendly interactions

Satisfaction with care – satisfying, enjoyable, patients would recommend to others, therapists felt Skype more useful as adjunct to usual practice

Patient benefits – reduced pain, improved function, improved confidence and self-efficacy.

A seventh theme arose from physiotherapists regarding:

Adjusting routine treatment – found they needed to modify their usual habits, felt some discomfort without hands-on, felt supported by research environment.

A selection of quotes from the patients and physiotherapists:

Patients (n=12)

Diana- “I found it really easy. I hadn’t done it before. It was really, really good. I really like it.”

Nathan- “You don’t have to go out, get dressed, travel … wait invariably…..it’s very convenient”

Carol- “Well I think it’s the way the world is moving…instead of wasting half an hour driving somewhere, and then finding a carpark and the costs involved and that sort of thing…”

Lois- “I could be in different places to use it…so I was able to Skype from work.”

Diana- “I didn’t have to go into town anywhere, because I live in the country ….”

Nathan- “It makes the follow-up and repetition of exercises easier, because you are doing them in the same room as you had the Skype session, using the same equipment”

Allan- “This sounds a bit crazy, but it was almost more personal …the therapist was coming to you”

Carol- “If I needed anything else in the future, I’d love to be able to book a Skype appointment”

Gemma – “I’d rave about it, I think it was great… I really enjoyed being part of the programme and part of that was because it was effective”

Jade- “They didn’t have to leave their house. That makes compliance much higher.”

Caitlin- “People who have mobility issues or simply can’t get to the clinic, it just opens up access”

Jamie- “Good to see them doing exercises in the environment they were going to do the exercises in … you can make sure they’re going to do it correctly on the chair you’ve got in your office but then when they go home they find all the chairs are lower and they can’t do it correctly….”

Bianca- “…wasn’t the option of getting bogged down with hands-on stuff …they understood from the outset that it was going to be exercises and be self-management and that you weren’t going to have large chunks of time taken up with hands-on things which might only give temporary relief.”

Gemma- “I did feel that it was quite easy to make a strong connection to the patients because they were in their own environment, and that made it better for me as a physio.”

Cody- “They all progressed really well in terms of strength and functional outcomes…A lot of the people were actually looking at surgery and then at the end thought they wouldn’t actually need it.”

_{(Source: Hinman et al. 2017)}⁴