Telehealth e-mentoring in postgraduate musculoskeletal physiotherapy education: A mixed methods case study to inform implementation for advanced clinical practice

Keywords: Telehealth e-mentoring, Advanced musculoskeletal practice, Professional development Purpose: Mentored clinical practice is central to development of advanced clinical practice in musculoskeletal physiotherapy, and core within national and international educational standards. Whilst mentoring is traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative, affording a unique andragogy to facilitate mentee critical reflection, deep learning and enhanced knowledge translation – all developed to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to specialist mentors often limited by clinic space, geography and cost, the potential value of telehealth e-mentoring is considerable. The purpose of this study was to understand the experiences and outcomes of/for multiple stakeholders (patients, student-mentees and mentors) engaged in musculoskeletal physiotherapy telehealth e-mentoring. Methods: Using case study design, sequential mixed methods explored stakeholder experiences of a 20-week telehealth e-mentoring service in a UK University as part of an advanced practice Masters programme. Quantitatively, validated outcome measures, patient participant experiences for care and empathy, patient empowerment and change in musculoskeletal health were collected at baseline and discharge. Qualitatively, semi-structured interviews exploring experiences of telehealth e-mentoring, including influence on critical thinking, clinical reasoning, communication skills, confidence, motivation, career enhancement etc. with mentee participants, and a focus group with mentor participants (topic guide informed by earlier analysis) were audio recorded and transcribed verbatim. Quantitative data were analysed using descriptive statistics (median, IQR) and qualitative data were analysed following the Framework Method. Trustworthiness was assured through reflexivity and code/recode audits with experts. Results: Data from patients (n = 90), mentees (n = 10) and mentors (n = 6) contributed to the developed analytic framework. Patients were aged median 42 years (18-73 years) presenting with a range of musculoskeletal complaints;n = 52 receiving follow up appointments. Of those followed up, improvements > MCID were clear, with MSK-HQ increasing by 11 points (MCID 6), Patient Specific Functional Scores improving by 4 points (MCID 2.7), and high scores for the Consultation and Relational Empathy and Patient Enablement Instrument. Mentors and mentees provided rich descriptions of their experiences. Main themes (sub-themes) for mentee participants’ included a) social learning (group mentorship, feedback, individualisation), b) advanced professional practice (communication, clinical reasoning, reflective practice), c) learner experience (expectation/acceptance, enjoyment/motivation) and c) limitations of telehealth (hands-on skill development, caseloads, therapeutic relationship). Mentor participants included a) preparedness (telehealth skills, relationship building, managing perceptions/expectations), b) journey of development (formative feedback, peer discussions, mimicking behaviours) and c) challenges (non-verbal communication, home environment, exercise prescription/goal-setting). Conclusion(s): Telehealth e-mentoring is an appropriate alternative to face-to-face mentored clinical practice, with improved patient outcomes and developed advanced musculoskeletal physiotherapy skills, knowledge and attributes. Planning for telehealth e-mentoring requires multi-stakeholder preparation, including setting expectations, embracing creativity in practice, and acquisition of technical skills. Impact: Adoption of telehealth e-mentoring may enhance opportunities for practice-based professional development and provide needed additional capacity to support profession specific skill development and service capability, to meet planned growth in advanced musculoskeletal physiotherapists. This study provides evidence from patients, mentees and mentors to support e-mentorship within teleheal h clinical practice. Preparation, planning and articulation of clear expectations are important to optimise the experience. Funding acknowledgements: Elsevier Research Award, MACP 2020

Group and individual telehealth for chronic musculoskeletal pain: A scoping review.

BACKGROUND CONTEXT: Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID-19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. OBJECTIVE: To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. DESIGN: A scoping review informed by the PRISMA extension for scoping reviews. DATA SOURCES: Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. STUDY SELECTION: Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. DATA EXTRACTION AND DATA SYNTHESIS: Data were extracted and synthesised using thematic analysis. RESULTS: From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self-management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. CONCLUSIONS AND IMPLICATIONS: Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.

Successful recovery following musculoskeletal trauma: protocol for a qualitative study of patients' and physiotherapists' perceptions.

BACKGROUND: Annually in the UK, 40,000-90,000 people are involved in a traumatic incident. Severity of injury and how well people recover from their injuries varies, with physiotherapy playing a key role in the rehabilitation process. Recovery is evaluated using multiple outcome measures for perceived levels of pain severity and quality of life. It is unclear however, what constitutes a successful recovery from injury throughout the course of recovery from the patient perspective, and whether this aligns with physiotherapists' perspectives. METHODS: A qualitative study using two approaches: Interpretive Phenomenological Analysis (IPA) using semi-structured interviews and thematic analysis following the Kreuger framework for focus groups. A purposive sample of 20 patients who have experienced musculoskeletal trauma within the past 4 weeks and 12 physiotherapists who manage this patient population will be recruited from a single trauma centre in the UK. Semi-structured interviews with patients at 4 weeks, 6 and 12 months following injury, and 2 focus groups with physiotherapists will be undertaken at one time point. Views and perceptions on the definition of recovery and what constitutes a successful recovery will be explored using both methods, with a focus on the lived experience and patient journey following musculoskeletal trauma, and how this changes through the process of recovery. Data from both the semi-structured interviews and focus groups will be analysed separately and then integrated and synthesised into key themes ensuring similarities and differences are identified. Strategies to ensure trustworthiness e.g., reflexivity will be employed. DISCUSSION: Recovery following musculoskeletal trauma is complex and understanding of the concept of successful recovery and how this changes over time following an injury is largely unknown. It is imperative to understand the patient perspective and whether these perceptions align with current views of physiotherapists. A greater understanding of recovery following musculoskeletal trauma has potential to change clinical care, optimise patient centred care and improve efficiency and clinical decision making during rehabilitation. This in turn can contribute to improved clinical effectiveness, patient outcome and patient satisfaction with potential service and economic cost savings. This study has ethical approval (IRAS 287781/REC 20/PR/0712).