Since January of 2020, registered physiotherapist David Friesen has travelled hundreds of miles to communities in and around Peterborough, including Lakefield, Belleville and Bobcaygeon, to provide at home physiotherapy care to clients.
In a typical week, David will normally see clients with a wide variety of injuries like concussion, traumatic brain injury and stroke. Injuries of this nature are commonly a result of motor vehicle collisions, workplace accidents, and high velocity and/or high impact mechanisms of injury, which require a different approach than common sports or work-related injuries.
When David and his family made the move from Toronto to Peterborough a year ago, he brought with him a wealth of experience working with neurological and complex orthopedic injuries that we knew would serve this community well. His main challenge this year has been to successfully translate his clients’ success in clinic to a home or community-based setting.
I sat down with David to talk about his experience launching our mobile physiotherapy clinic in Peterborough, especially in light of a global pandemic. He gave me the lowdown on building new relationships in a lockdown, barriers to providing physiotherapy without a physical clinic space with equipment, the many upsides of this mode of therapy and some common challenges that therapists face in providing in-home physiotherapy care.
At Home Physiotherapy for Seniors
A large segment of David’s clientele is elderly. This makes sense when you think that people over the age of 65 make up more than a quarter of the population of Peterborough. For this demographic, travelling from their homes — sometimes in remote corners of the Kawarthas — may not be desirable or even possible.
At home physiotherapy gives these individuals access to services for individuals who are unable to get to the clinic for a variety of reasons. For example, people with severe mobility impairments, those unable to organize transportation, or people living with significant anxiety or stress when exiting their home can still access physiotherapy services.
The pandemic has been particularly difficult for people who already feel isolated and face barriers in accessing services. From this perspective, launching a mobile physiotherapy clinic in 2020 could not have been more timely.
“During the pandemic my mood and motivation was quickly declining. I was used to going to multiple therapists a week and that suddenly was cut off. David was able to meet me in my neighbourhood park and safely provide physiotherapy sessions. Without these weekly sessions, I think I would have declined much more during this isolating time away from other people, both physically and mentally,” said one client.
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Creative Solutions for At Home Physiotherapy
Propel Physiotherapy’s 4,500-square-foot clinic space in Etobicoke is completely decked out with state-of-the-art equipment, a fully accessible gym and private treatment rooms. Coming from that work environment, would definitely be an adjustment for any therapist. It takes some serious creativity and ingenuity to provide clients with a comparable, if not superior, home-based program experience. Luckily for his clients, David is always up for the challenge.
Access to equipment that we would typically use in the clinic, like a treadmill, stationary bike or weight machines is often a problem. Of course, there are some clients who already have exercise equipment in their homes or buildings. For many though, we need to pivot and find a workable solution.
David works with the client to find a suitable alternative that is appealing, affordable and motivating to the client. David can put together a home exercise kit package customized to fit the client’s needs, home and surroundings and then place the order on behalf of the client.
In cases where the cost is prohibitive, David can find objects in the client’s home to translate. For example, a plastic water bottle can be refilled and used as a weight. As an alternative to cardio machines, doing stairs in the client’s home can work just as well whether that is just using the bottom step repeatedly or ascending and descending a full flight repeatedly.
It can often be intimidating for people who have suffered a serious injury to reintegrate into the community. This is especially true with longer recovery that may have required hospitalization and months of recovery at home. David understands the particular needs of his clients and will encourage them to move beyond their comfort zone at a pace that is optimal. If and when the client is comfortable getting outside again, going for a brisk walk could be just the right prescription.
The Benefits of At Home Physiotherapy
If ever there was any doubt about the quality of services and outcomes delivered through mobile physiotherapy, David can erase it with client success stories and anecdotal evidence. It would be fair to say that he is a complete convert himself — now believing at home physiotherapy to be superior — and that we might have a tough time getting him settled back into a clinic routine in the future.
The benefits of at home physiotherapy extend both ways — to the client and the therapist — in many cases. The convenience of having a physiotherapist come to your home eliminates barriers faced by those who can’t drive, access a ride or even travel in a car without experiencing a flare up of symptoms. This improved access to therapy makes it easier for clients to be an active participant in their recovery.
David has noted there aren’t as many session cancellations with his home-based therapy clients. This is obviously great for us from a business perspective. In terms of the client, it means stronger adherence to the program of care that David has put together which will help achieve goals set out in the client’s treatment plan.
Being able to interact with clients in their home and/or community and setting enables David to see how the client moves and completes tasks in their everyday life. Setting goals therefore becomes more concrete and applicable, like being able to walk to the mailbox.
In certain cases, results and progress can actually be more effective with at home physiotherapy than in clinic. For example, David told me, “I recently had a client with a past stroke show me how she can now stand up from her chair and toilet without using her hands, which she could never do before. This was one of the first goals we worked on in her home, because it was very obvious that she was compensating greatly every time she had to stand up or sit down on the low chairs in her home. “
“We modified her chair by adding a pretty significant pillow, and she practiced with that pillow until I came back. Two weeks later I showed up and she proudly demonstrated how she had progressed herself to a thinner pillow and was still able to stand up with ease. Without seeing her in her home setting I really don’t think we would have seen that kind of quick and functional progress!”
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