Dr Fiona Graham
Like a lot of life’s turning points, it started with a throw-away comment: ‘Someone should study that and see if it really works.’
I made the comment to Sally Wallace, an occupational therapist colleague who was playing around with telehealth (video-conferencing, photo-sharing, phone calls) with clients with complex wheelchair and seating needs – most of whom had neuro-muscular changes among their physical needs.
This was a few years ‘BC’ (Before Covid-19) so technology software and hardware was more limited than it is today, especially within the health system.
Sally was finding that telehealth seemed to work with some people, and often it wasn’t the complexity of client’s needs that determined whether telehealth assessments were successful or not.
We noted too that very few wheelchair assessors used telehealth at that point. Why was this?
Telehealth wheelchair assessment seemed to save time and money, but did it really when all the costs were added up?
Who did telehealth wheelchair assessment work for, how well, and in what context was all a great unknown. If telehealth was to be used more extensively in Aotearoa, the answers to these questions were important to ensure that the health dollar was well spent.
Like a lot of life’s turning points, my comment was then followed by a lot of hard work.
First, without project funding, a group of my colleagues at Te Whare Whakamatutu (Rehabilitation Teaching & Research) at the University of Otago in Wellington decided to canvas the research literature on what was already known about the use of telehealth for wheelchair assessment.
We did a scoping review of research to date and found that minimal research had been done. Lab testing reported equivalent results between in-person and telehealth wheelchair assessment.
Clients were big fans when it improved their access to assessors. Assessors were more cautious, with concerns about data security and clinical accuracy. Clearly, assuming that telehealth was a great idea and everyone in New Zealand should now do it was a risky assumption.
So, with a view to informing health policy on the New Zealand design requirements of a successful telehealth wheelchair assessment service, we applied to the Neuromuscular Research Fund in 2018 and were awarded $17,000 to determine the social and technical requirements of a Telehealth Wheelchair Assessment Service (T’WAS for short).
Our work was also generously supported by an advisory group comprising wheelchair users, tangata whenua, assessors and assessor educators and students.
We took a grass roots approach, seeking the views of wheelchair users, their families, specialist and non-specialist assessors and technicians. We also sought the views of service managers, funders and policy writers, although only recruited service managers.
Understanding the perspective of Māori was also a priority. Over 12 months, 117 people (including 47 wheelchair users, 49 wheelchair assessors, nine family members, six technicians and three service managers) shared their views about a T’WAS through a survey, and 41 also through interviews. Māori represented 12 percent of responses.
Surprisingly, most respondents thought T’WAS was a good idea, although cautioned that it shouldn’t be the only option. Unlike our scoping review findings, assessors were enthusiastic about it, although few of them were using it.
Wheelchair users, including Māori, were better equipped than assessors with the technology in place to meet via telehealth. Tablets seemed to be the optimal hardware and simple, off the shelf software (e.g., Zoom) was preferred.
The key impact voiced by all stakeholders was more timely assessment than the current in-person system allowed. Frustration with the current system was loudly expressed.
Māori were enthusiastic for T’WAS generally. While one Māori assessor questioned the quality of whanaungatanga (relationship building) for Māori through telehealth, Māori wheelchair users commented that telehealth could level the playing field, and improve the experience of being culturally safe. As one Māori wheelchair user put it:
“I think having it [wheelchair assessment] done by a video link could improve the [cultural and personal] safety of these consultations…You can just hang up if you feel unsafe. You know you have control in that moment because it’s a lot more even playing field than when therapists are in your house.”
We have already shared the findings from this study with assessors through several professional development workshops and shared findings in person with Ministry of Health planners. Two peer reviewed publications are in
progress.
Feedback so far is that findings have prompted big insights for many assessors on how their interactions with wheelchair users might be experienced, in-person or via telehealth, and demystified what T’WAS could look like.
We are currently pursuing funding for our next step, to take a detailed look into attempts to do telehealth wheelchair assessments. We’ll map out the context around when T’WAS can work, doesn’t work and the steps that make it more
likely to be a positive outcome for everyone. We hope to create a freely accessible resource for assessors and wheelchair users as a key output of this next project.
To access a series of publicly available workshops on telehealth that drew from study findings, go to: www.youtube.com/watch?v=YebdoSmNAaU.
To access full copies of the peer reviewed articles email fi.graham@otago.ac.nz.
Special thanks to our advisory group members: Pete Williams, Hemakumar Devan, Siobhan Jansen, Rita Robinson, Johnny Bourke, David Hood, Stephanie Thompson and Michael Nolan.
* Dr Fiona (Fi) Graham is a Senior Lecturer in the Rehabilitation Teaching and Research Unit in the University of Otago’s Department Of Medicine.
* This article was originally published in the Autumn 2021 edition of In Touch magazine.
For more information please contact:
Melanie Louden
Communications and Marketing Advisor
Muscular Dystrophy Association of New Zealand
027 509 8774
melanie.louden@mda.org.nz
