Guest Blog by Adam Partington, Suzanne Ackerley, and Louise Connell
About Us
Adam Partington. I am a Neuro Physio working in Stroke and Neuro rehabilitation for the past 9 years. Over the last 12 months, I’ve stepped up as Operational Lead of NeuroRehabilitation OnLine (NROL) in Lancashire and South Cumbria. I have an ongoing interest in group rehab and how we can assess innovative interventions to increase therapy intensity whilst maintaining quality of treatment. I continue to keep my ‘foot in the door’ whenever I can to provide therapy to patients and often deliver sessions on the program.
Suzanne Ackerley. I am a clinical academic physiotherapist focused on improving outcomes in stroke and neurological rehabilitation. As a Research Fellow at the University of Central Lancashire and in partnership with East Lancashire Hospitals NHS Trust, I have helped lead the implementation and evaluation of NROL in the North-West and have been excited to see it transition from an idea to a regional innovation.
Louise Connell. I am a physiotherapist in a clinical academic professorial role at Lancaster University and East Lancashire Hospitals NHS Trust. I was responsible for getting NROL going at ELHT, and have led the implementation and evaluation of NROL including the ongoing challenge of securing funding!
What we did
We had the amazing opportunity to develop a programme called NeuroRehabilitation OnLine (NROL). This allowed patients, with support, to access group physical, talking and community focused therapy online from their own homes using the Microsoft Teams platform. NROL was an additional complement to their existing rehabilitation. Initially run at a single NHS Trust, but as it went so well we fortunately received funding to expand it regionally across Lancashire and South Cumbria. All of this wouldn’t have been possible without a strong clinical academic partnership, and charity (SameYou) and NHS England support. For more information on NROL see: https://elht.nhs.uk/services/integrated-therapy-service/neuro-rehabilitation-online
Why did we do it
We did it because we know patients need more therapy to reach their potential, but we also know how challenging therapy colleagues were finding it to increase the amount with limited staffing and resources. New clinical guidelines aligned with this too, emphasising the need to provide more therapy sessions for our patients. The development of digital and virtual treatment options trialled during the pandemic gave us a great opportunity to try something new! We wanted to look at how we could work together to deliver more rehabilitation. Ultimately, joining forces across 4 NHS Trusts across our region we aimed to change the landscape of stroke and neurological rehabilitation.
What was the outcome
Overall patients love it! Although there was some initial scepticism, most patients thrived in the online group therapy environment. Often explaining how they ‘didn’t feel alone’ and ‘were able to speak to others’ about their issues and progress, and this made it extremely ‘relevant’ for them. The group content includes a mixture of education, exercises, practice and group discussion. Most patients found this an excellent adjunct to their face-to-face therapy, and this was reflected with improvements in measured quality of life and their ability to perform activities important to them. Frequent comments like ‘I didn’t want it to end’ and ‘I had something to look forward to each week’ helped us understand the impact NROL has had on our patients’ rehab journey. See the link for Bob’s Story all about his NROL experience: https://youtu.be/v-tqjirB80Y.
Let’s not forget the staff, they seem to have embraced this regional innovation, recognising that it has allowed an increase in therapy without sacrificing quality. In fact, our preliminary analysis shows NROL has the potential to double the amount of therapy our patients receive. We’ve also noted benefits in terms of time, energy and travel. Staff (or patients) don’t need to leave the office (or home) for these sessions. In real terms this travel saving since April 2023 is equivalent to the distance from Land’s End to John O’Groats 80 times! So, it saves both driving time and mileage, which may free up therapist time and improve resource allocation.
We keep continually evaluating NROL to look at how we can improve our offer and to consider how this model of care may have potential application in other areas of healthcare.
What have we learnt
Online therapy works, but we totally understand it is not a ‘one size fits all’ approach. We did however come to realise that more patients could and would access it than we originally thought. Having technology assistance for patients to get online was key. Some patients explained that they had been willing to ‘give up’ on the online option but that ‘having someone on hand to support’ enabled them to ‘get online and stay online’. They expressed their interest in utilising their new tech skills going forwards too!
We found overall that patients love to connect with one another, and telehealth helped enable this. We have lost count of the number of times patients have described their relief that other people are going through the same experiences and challenges post stroke/neurological diagnosis. Through NROL they described being able to see the ‘light at the end of the tunnel’ through sharing experiences, strategies and even some healthy competition in the physical exercise sessions!
We can’t forget all our brilliant staff who have been so engaging throughout, sharing their knowledge and skills with patients but also upskilling other staff to deliver online content too. It hasn’t been without it challenges as working online requires regular effort to keep us ‘visible’ and maintain appropriate service involvement especially with the steady increase in referrals over time!
Although it was a big step taking a regional approach to delivery it has provided lots of benefits, with a notable one being that it created communication and networking opportunities for staff across the Trusts. We think this helps us continue our focus on facilitating equitable services.
What are your 3 top tips for others wanting to use technologies in rehabilitation
- Provide Technology Support – Providing initial and ongoing support to download, login and maintain connection was essential to success. It enabled our patients and staff to gain the skills and confidence to get online and continue to do this week in week out. Without this element we could confidently say our service wouldn’t be what it is today!
- Ensure Stakeholder engagement – From day one we aimed to have key stakeholders involved in co-producing NROL whether this was therapists, patients, admin etc. but also the management and decision-makers. We worked together to figure out good processes for structuring and evaluating delivery, and the best ways to communicate within teams. This has resulted in interest in NROL both regionally and nationally. Even with this success, trying to bring about a change in commissioner mindset to fund the service long-term hasn’t been without its challenges.
- Find your ‘Champions’ – Find really engaged therapists who ‘get’ the concept and are really good at it! They can then go back to their teams and inspire others. Having regular communication with them keeps the drive forward and in the ‘hearts and souls’ of daily rehabilitation. Remind them, working at a regional scale means we have more therapists to choose which places less demands on individuals but also on the service. We are all in it together to give our patients the best we can offer!