How has COVID-19 changed access to physiotherapy services?

While private physiotherapy practices remained open during the second lockdown, this does has not, of course, meant a return to business as usual. Appointments have still been conducted virtually where appropriate and Physio First, the trade association for chartered physiotherapists in private practice, has produced guidance for re-opening private practice which emphasises the importance of legal and health and safety guidelines being adhered to, particularly when it comes to the use of PPE.

Nevertheless, the clarification from Public Health England that ‘medical and health services’ to stay open included private physiotherapy was welcomed by the CSP. It is, after all, a means by which patients can continue to be seen for conditions that may seriously affect their day-to-day lives.

But should patients still be attending private physios in person in the current climate? And what treatments are still available if you have had an accident and need access to rehabilitation services?

It seems that in-person appointments have remained, and will continue to remain, very popular, and they are going ahead where proper COVID-19 safety arrangements have been put into place. These include remote assessment prior to any face-to-face appointment, to establish whether in-person contact is appropriate; time between clients for physios to clean the consulting rooms; not using waiting rooms but escorting clients (at a distance) directly from the entrance to the treatment area; and physios in full PPE.

How do physios see things?

We spoke to three Oxfordshire-based physiotherapists about how COVID has changed things for them.

Physio Sarah Baimbridge (the Banbury Private Physiotherapy Practice) told us that her practice maintains a proactive approach towards face to face consultations with exercise being the main platform for rehabilitation – hands-on treatment being provided only when necessary, and with a firm triage process in pace to ensure strict safety within clinic practice. As such, the CSP and Physio First guidance is at the forefront of any clinical decision for each client, regardless of business needs. All of the physios we spoke to agreed that most patients want to be seen in person, but Sarah clarified that many of the exercises can be done side-by-side rather than requiring physical contact with the practitioner.

Nonetheless another physio, Pete Quartly (Physio Lab Oxford), informed us that the demographic of his clients has shifted dramatically; much of his clientele who are over 65 appear to be taking a more cautious approach to in-person appointments, despite not actually falling into a high-risk category. Sarah also raised concerns about this, saying that some older clients with deteriorating mobility could be more at risk of COVID if they are not seen by a physio than from attending the clinic in person. This is because they are at risk of a potential deterioration in their physical condition if they don’t receive the physiotherapy they need in order to maintain and improve mobility, and thereby their overall health - and this is likely to need to be face-to-face physiotherapy. She is also concerned at the rise in exercise-induced injuries for those who have followed YouTube or other regimes without receiving appropriate advice about what is safe exercise given their medical histories.

Pete explained the categories of risk he uses in order to assess if clients are suitable for face-to-face treatment, which include:

• high-risk (includes diabetics, cancer sufferers, severe heart, lung disease, had an organ transplant, underlying conditions that increase the risk of infection, rheumatoid arthritis, and those who take any medication that supresses the immune system - these cases are seen remotely);
• medium risk is everyone else; except
• low risk who are those who have had a negative COVID test in the 24 hours prior to contacting the clinic.

His practice is therefore focused on medium-risk patients and he, like all the other physios we spoke to, therefore takes appropriate precautions to ensure both client and physio are as safe as they can be.

Physio Tom Jacobs (Flex Physiotherapy Practice Oxford and Didcot) told us his message to patients looking for an appointment is that they will need to be flexible: ‘If you have a muscle or joint-related issue, contact your GP in the first instance if you are concerned’, he explains.

‘If it’s something that you don’t think needs the GP’s attention or you don’t wish to bother them, you can self-refer to Physiotherapy. This can be done through the NHS but you may have to wait for an appointment, and it is likely to be done over the telephone. If you want to see a physio in person, there are lots of private clinics around offering this service, and with most of them you can check that they are Covid-secure like ours at Flex Physiotherapy Practice by looking at their website.

Bear in mind you may see references to triage: all this means is that there would be a five minute phone call or virtual screening tool to check that you are suitable for face-to-face treatment. Many clinics also offer video link consultations for those who don’t want to attend in-person.’

The message from all of the physios we spoke to seems to be that they are keen to see clients both remotely and face-to-face depending on what is appropriate. They are also keen to reassure the public that every precaution is being taken to make sure that the risk of infection is minimal - so even if it means you are faced with a practitioner in visor, mask, apron, gloves, and a temperature check at the door, the advice is not to be put off if you need to keep accessing treatment.