1. Physiotherapy at a distance - the patients' experiences Lisbeth Eriksson, RPT, Fil. Dr. The County Council of Norrbotten 2012-06-20

2. Content E-health project Clinical research Effects and the patients’ experiences of physiotherapy at a distance Possible reasons Conclusions and understanding Where we stand today Questions

3. Physiotherapy at a distance It all started 1998… To see and hear each other at a distance

4. The County Council of Norrbotten Ca 30 sh.surgery/year 35 primary care center Sunderby Sjukhus

7. Results Clinical good results Research Patients’ experiences Individual interviews

8. Distance groupControl group 10 12 53 - 85 50 - 86 Shoulder joint replacement Osteoarthrosis, rheumatoid arthritis The patients experiences of two months pysiotherapy at a distance at home

9. Findings A different reinforced communication Pain-free exercising as an effective routine From a dependent patient to a strengthened person at home Closeness at a distance Facilitated daily living Continuous physiotherapy chain At home Physio- therapy at the hospital Outpatient physio- therapy Theme Access to continuous specific physiotherapy at home is a prerequisite for recovery

10. A different communication (What was the feeling of seeing your self at the image?) ” Well, a bit exiting actual…,I was a bit astonished, yes, it was little hard. Is that the way I look like?...okey … mm (laughs).” 2-3 days From results

11. A reinforced communication In the physiotherapists focus. In the centre of the physiotherapists attention – spoke and exercising. Listening with close attention and no interruption. Respect and regard.

12. ”I was very careful at the beginning and was thinking… how is it feeling… is it starting to hurt... I was a little afraid… to move the arm, but it started to go better and better after some time. I think it was this special training especially of shoulders... And it became a daily routine” Pain-free exercising as an effective routine

13. Initially a dependent patient ” It is easy… to be depressed right after the surgery when you can´t move, but now I had something to look forward to, the whole time… You have to be a little self-centred the first time (after surgery)… ” Finally a strenghten person ”I have became an expert on my body!”.

14. Closeness at a distance “She came home to me, yes, she came in to my house. The only thing she couldn´t do was to touch me… But we could not drink coffee together (laughs).”

15. Facilitated daily living “I can turn on the TV, and the pan on the stove to cook in the kitchen, and it does not matter. I go back there when the training is completed.”

16. Continuing at the outpatient physiotherapy “I think it is fine to go there now where they have these training equipment.”

17. Possible reasons for the results An userfriendly technique Increasing access to specific physiotherapy with a shorter delay between discharge and continued treatment at home (D-gr 1-2d, C-gr 7-15d). Physiotherapy at a distances have effectively adapted to the individual patient's need. Greater need immediately after discharge, reduction to about 10 min follow-up with guidance and advice Increased comfort and less risk of newly operated patients with pain and discomfort. Higher rated degree of health related quality of life (sign)

18. Reasons… Faster and greater improvement; pain and functional ability and health related quality of life (pain and vitality, sign). Distance spanning; more treatment sessions The continuity without interruption

19. A safe and available technique for persons with cronic diseases after a shoulder surgery. A safe and strenghten patient at home. Access to frequent support, feedback, continuity and reinforced communication. Specific body knowledge and being at home were aspects contributing to an enhanced recovery competence. Conclusion

20. My understanding The development of online, interactive and patient-centered physiotherapy focuses on Patient’s participation. More involved in their care Another way of working. Not using the hands Pedagogic role, communication, empathy and understanding of the patient.

21. Physiotherapy at a distance at Sunderby hospital, Luleå Implemented for patients who have undergone a shoulder joint replacement. Tested for patients with Parkinson disease. Complement instead of replacing the physical meeting between patient and physiotherapist.

22. Tack för visad uppmärksamhet! Thank you! lisbeth.eriksson@nll.se