Relationship-driven, family-centered care via TelePT: Reflections in the wake of COVID-19

Abstract

In response to the throttling of children’s therapy programs precipitated by COVID-19 shutdowns, interest in the use of telehealth has increased among service providers at both the clinical and administrative levels. TelePT promises to be particularly appropriate in devising programs of on-going, therapeutic exercise interventions for children with neuromotor disorders. From the lay perspective, physical/physiotherapy (PT) which is seemingly characterized by the “hands-on,” and corrective approach to managing impairments, makes it a counter-intuitive candidate for delivery over telehealth. Over the past decades, however, PT as a discipline has increasingly adhered to a relationship-driven, family-centered model of intervention. This model is “hands-off,” figuratively if not always literally, and hence is not necessarily disconsonant with delivery mediated by telehealth technology. The current study explores in-depth the experiences and reflections of seven practicing therapists, on the impact of telehealth, telePT on the operationalization of relationship-based, family-centered methods into therapy. Interpretative phenomenological analysis was selected as the analytic method for understanding participants’ experience providing services using both distance and standard face-to-face practice modalities. Results identified eight principal themes emerging from participants’ descriptions of their experience of delivering therapy over telePT. Four of these themes correspond to the tenets of relationship-driven, family-centered care identified across four frameworks applied to pediatric rehabilitation. The remaining four themes focus on the particularities of the telePT modality and its viability in clinical practice. The ability telePT afforded to “see into the child’s environment” emerged arguably as the greatest value of the modality in patient care. It revealed to therapists so much that they did not know about their patients’ progress and, more strikingly, had not realized they did not know. TelePT provides a unique window into the child’s functioning in the hours he is not in therapy. Given its potential in parent–therapist relationship building, assuring the ecological validity of therapy programs, and the empowerment of families who seek it, telePT is likely to be part of the future of PT and one driver of its evolution as a profession. There is a compelling case to retain telePT modalities offering them alongside in-person formats for convenience, safety, and service quality enhancement.

Evolution of a System to Monitor Infant Neuromotor Development in the Home: Lessons from COVID-19

“…Pre-COVID-19, it was not uncommon for early interventionists, therapists who provide services for children in their homes, to be left to work with the child while the parent dealt with other tasks. After lockdown, when therapy shifted to telehealth, the parent had to be engaged, an active partner in the home therapy program, as young children do not have the knowledge or skill to manage interactions over telehealth autonomously [ 17 ]. This scenario parallels our experience in HUGS-1, where parents often seemed tentative, as if they did not want to “interfere” with the HUGS session.…”

“…The in-person environment of the clinic is regulated by practitioners, whereas the telehealth environment of the home is under the pediatric patient family’s control. This shift in the service delivery environment provided an unexpected practicum for authentic, relationship-based, family-centered care [ 17 ].…”

“…The rationale for this approach is that the program that aligns well with family life is the one that is most likely to be successful. Therapists found that even though they accepted the premises of RDFCC prior to COVID-19, having to work with families from a distance helped them hone their skills and discover better ways of helping families integrate therapy into their child’s daily life [ 17 ].…”

Testimonios de españoles amputados de extremidades durante el aislamiento social por la pandemia de la COVID 19: impactos en la movilidad física

“…El paradigma, las estructuras del pensamiento, inscritas culturalmente en los seres humanos, inconscientemente gobiernan su forma de conocer, pensar y actuar (Morin, 1998). Choong et al (2022) destacan que el interés en el uso de la telesalud fue precipitado entre los proveedores de servicios, tanto a nivel clínico como administrativo, por los cierres de la COVID 19. Señalan que la telesalud puede ser particularmente apropiada en la elaboración de programas de intervenciones continuas de ejercicios terapéuticos, sobre todo por la fisioterapia, caracterizada por el enfoque "práctico" y correctivo en la gestión de las deficiencias.…”