Providing Occupational Health Triage remotely A Physiotherapy service

Key Learning Outcomes What part does telephone based physiotherapy have to play in Occupational Health? What is telephone based physiotherapy ? How does it work for patients?

Challenges faced by OH department Delays to treatment for staff Days off work Difficult to return to work What level of function can the perform?

How important is Early Intervention? Working for a healthier tomorrow Dame Carol Black's Review of the health of Britain's working age population 2008

Rapid Access Physiotherapy via a telephone assessment The right advice and reassurance at the right time, directing patients to the most appropriate clinical pathway for the best treatment outcome for them. We currently use this model very successfully with a number of companies and via Occupational Health, have been able to give the correct care to all employees working inside the UK . It is effective in getting early intervention to employees, for example staff who work on oil rigs, where previously there would be no immediate access to physiotherapy intervention.

How important is Early Intervention? Early intervention for MSK injuries – better outcomes Treatment- and Cost-Effectiveness of Early Intervention for Acute Low-Back Pain Patients: A One-Year Prospective Study 2003 Gatchal et al

How important is Early Intervention? Employers wanting to prevent and control absenteeism Employees are able to return to work quicker and perform their job tasks No GP appointment – quicker access Referral from line manager into the service to allow intervention in a shorter time frame Employees working remotely (i.e. oil rigs) access to Physiotherapy advice and intervention

What is telephone based assessment? Physiotherapy subjective assessment Present History Mechanism of Injury Aggravates and Eases 24 hour pattern Past Medical History Red Flags Functional Requirement for Job Role Clinical reasoning = Clinical hypothesis

Tailored to Occupational Health Job Role descriptions – understanding the functional requirements for each job role Work Related Function – Report back to Line Manager Able/Restricted/Not Able Stooping Crawling Walking Kneeling Sitting Standing Lifting

Example of a Job Role Technical Engineer Walking Standing Sitting for driving Bending/Stooping Squatting Kneeling Climbing up steps Gripping/handling Reaching above shoulder height

Next steps from triage A&E: Red flags screening on all patients Supporting Self – Management: we support the patient to take them through exercises and changes to Musculoskeletal wellbeing by telephone coaching reinforced with video and written material Manual Physiotherapy GP: non-MSK or need Consultant input On-going Case Management: to support the patient throughout their journey .

Study of Effectiveness of Triage vs. Manual Therapy Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial Salisbury, Montgomery et al January 2013 Conclusion: PhysioDirect is equally clinically effective compared with usual care, provides faster access to physiotherapy. (7 days vs. 34 days)

Challenges with the service “Telephone Assessment…??” “Why can’t I see a physio face to face?” “Can they really help me over the phone?” “One more step before I can get some help”

Service impact The service has been running since 2007. For 16% of employees, Telephone assessment manages their condition without a face to face appointment being required Customer Satisfaction survey average above 80% for past 2 years

Service impact Return to work for only those who had reported being off work at Initial Assessment: Full Return to Work: over 80% Partial Return to Work: over 13 % Unfit to Return to Work: less than 6%

Any Questions Please?