Tele-assisted physiotherapy, insufficient for chronic and vulnerable users

Confinement by COVID-19 was particularly detrimental to chronic users of physiotherapy, such as people with disabilities and those suffering from neurodegenerative or cognitive pathologies, as well as geriatric patients. Even "completely autonomous people reached a state of dependency". This is according to research by the Universitat de Lleida (UdL) published in the journal Physiotherapy Research International. The qualitative study also highlights the technological barriers of telecare for vulnerable groups such as families without resources, migrants, people in situations of dependency or people with low digital literacy.

Researchers at the Faculty of Nursing and Physiotherapy (FIF) of the UdL -most of them members of the research groups Society, Health, Education and Culture Studies (GESEC) of the University and Health Cures (GReCS) of the IRBLleida- have studied the impact of the pandemic on the work of physiotherapists, both in the public and private sectors. "This work shows that the reduction of physiotherapy services to emergency departments in the first months of the pandemic in Spain had a negative impact on the health of users, increasing the disability and dependence of people with chronic neurodegenerative diseases and geriatric users," explains professor and researcher at the UdL Helena Fernández Lago. "The pandemic also had an impact on demand management, further highlighting the importance of defining the triage process and physiotherapy protocols in the emergency department," she stresses.

The interviews conducted with professionals in Catalonia and Galicia - 13 women and 3 men, aged between 24 and 44 - reveal a worsening of the state of health of people with neurodegenerative or cognitive pathologies who developed medical complications such as sensory hemineglect, i.e. a deficit in the awareness of contralateral stimuli. In the case of geriatric users, in addition to the impact of confinement on an emotional level due to loneliness, physiotherapists describe large losses in functionality and quality of life, partly due to increased sarcopenia (loss of too much and too much muscle). For all these reasons, they speak of a "devastating impact" on older people with chronic pathologies. They also mention the general worsening of the physical health status of paediatric physiotherapy users.

The confinement and limitation of face-to-face clinical care has led to a trend towards a non-interventional service, with the impulse of tele-assisted physiotherapy, as in other countries such as Italy, Brazil and the United States. The limitations of manual therapy have encouraged telematic care, which professionals consider positive for people with chronic musculoskeletal pathologies. However, the use of ICTs was a challenge, especially for professionals and users with low digital literacy. They describe "technological barriers to carry out telerehabilitation in families without resources and in migrants, as well as linguistic and cultural barriers, and also with neurological patients and in situations of dependency".

Researchers from the Faculty of Nursing and Physiotherapy of the UdL have also led another article on COVID-19 confinement, in this case published in International Journal of Environmental Research and Public Health. The findings of this qualitative study - conducted with staff from the universities of Alicante and Autónoma de Madrid - indicate that mothers who had to balance telework with family life suffered physical, mental and social effects such as anxiety, stress, sleep deprivation and relationship problems. The research suggests that, in crisis situations, gender inequality increases at home and women tend to revert to traditional roles.

Articles:

• Fernández-Lago H, Climent-Sanz C, Bravo C, Bosch-Barceló P, Masbernat-Almenara M, Sanjuan-Sánchez D, Briones-Vozmediano E. Physiotherapists' experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain. Physiother Res Int. 2023 May 19:e2015. doi: 10.1002/pri.2015. Epub ahead of print. PMID: 37203867.

• Loezar-Hernández M, Briones-Vozmediano E, Ronda-Pérez E, Otero-García L. Juggling during Lockdown: Balancing Telework and Family Life in Pandemic Times and Its Perceived Consequences for the Health and Wellbeing of Working Women. Int J Environ Res Public Health. 2023 Mar 8;20(6):4781. doi: 10.3390/ijerph20064781. PMID: 36981690; PMCID: PMC10049029.

Text: Press Office of the University of Lleida