A guest blog from Emily Graham and Vicky Lewis-Baldy, physiotherapists at the Royal National Hospital for Rheumatic Diseases
December 2020: How to review a year that has been overtaken by a global pandemic?
In September 2019 we moved from our beloved Mineral Hospital in Bath to our new purpose-built Brownsword Therapies Centre on the Royal United Hospital site. Our AxSpA course continued with patients enjoying access to the new state-of-the-art hydrotherapy pool. Then suddenly, as with the rest of the UK, our services came head to head with COVID-19. Our outpatient clinics closed and we were redeployed to work frontline on the wards. It was a really tough time for us in many ways, especially feeling we were abandoning our Rheumatology patients.
After just over three months, we were able to start to think about resurrecting our services, and discussions began about how we could specifically support our AxSpA patients. Our lead consultant, Dr Raj Sengupta, tasked us with finding a way to make the AxSpA course work online. Cue four months of very hard but rewarding work!
To kick off the process we were very fortunate to have the support of our lovely colleagues Mel and Fran at the Bath Institute for Rheumatic Diseases who facilitated patient engagement sessions. These helped us to ensure we were covering the topics that were most important to our patients, as well as considering the optimal length of sessions, and available technology.
We reviewed the previous course contents to ensure we were using the most up to date evidence. We met individually with each member of our multi-disciplinary team: our clinical nurse specialists, podiatrist, nutritionist, research nurses, occupational therapists, consultants and psychologist – to look at how they could best contribute to a virtual course. We deliberated over the course timetable – we wanted to ensure a good mixture of education and exercise sessions, and limit prolonged screen time. We worked hard to create a variety of content – including live sessions, pre-recorded presentations and a new participant workbook. We also created exercise and stretches videos to allow people to watch and follow at home.
Finally, we needed to put it to the test! We were very fortunate to recruit four fantastic participants for our pilot course. They were brilliant: patient, engaged and generous with their feedback.
One of our greatest challenges has been how to assess patients virtually, in place of the normal face to face BASMI measures. We are currently trialling a visual representation of the core BASMI measurements taken pre and post-course, and using additional functional outcome measures. We have enjoyed reading the recent AStretch blog reporting testing of the Home-BASMI and seeing how others are tackling this issue. We also continue to work with our University of Bath colleagues who are exploring the digital measuring of spinal movements.
We have enjoyed really good feedback from participants, and our Trust Chief Executive, Cara Charles-Barks, recently awarded us Team of The Month (see below)
We do really miss our face to face patient contact, and of course the luxury of daily hydro sessions! There are, however, plenty of positives to take from our new arrangements – participants don’t need to travel (easier to balance with home life plus greener and cheaper) – they can easily reproduce all the exercise sessions at home– and we get to see the odd pet on screen!
It has been a huge learning experience for us all – and the course is ever-evolving. We are enjoying sharing our experience with other teams as they transition their content online. 2020 has definitely been a year most of us would choose to forget, but for our AxSpA patients COVID-19 has really proved necessity is the mother of creation – and we are proud to take our course forward into the future.
We would like to take this opportunity to thank everyone that helped us with the process.
For more information please visit our website: https://www.ruh.nhs.uk/AxSpAService
Emily Graham and Vicky Lewis-Baldy