The User-led Development of Web-based Physio for People with Spinal Cord Injury Dr Elaine Coulter1, Dr Alan McLean2, Mr Jon Hasler2, Mr David Allan2, Dr Lorna Paul1 1School of Medicine, University of Glasgow, Glasgow, UK; 2Queen Elizabeth National Spinal Injuries Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Background People with a Spinal Cord Injury (SCI) are at a higher risk of Cardiovascular Disease and Diabetes and have a higher rate of mortality than their able bodied counterparts. Physical Activity (PA) and exercise are especially important for people with a SCI and can increase the amount of lean muscle; resulting in better weight management and reduce disease risk.
In light of comments received, new exercises were filmed and uploaded to the website while some exercises already on the website library were suitable for some injury levels. Advice pages were written in collaboration with specialists on the benefits of PA and exercise, autonomic dysreflexia and skin care. Views and feedback on the website were obtained again with specialists and four people with SCI (3 male; 2 paraplegia; >2 year since SCI).
Telerehabilitation may provide a feasible option and may be useful for people who are unable to access ‘conventional’ rehabilitation or gyms such as those who live in rural locations, are housebound, have childcare commitments or transport problems. Our group developed webbased physio, www.webbasedphysio.com, which consists of:
People with a SCI were positive about web-based physio, reporting they liked the colours, the format of the website, that it was easy to use and they felt it was important to watch someone in the videos, similar to themselves, that they could relate to. They reported feeling isolated after discharge and that continuing with exercise is difficult. Most people with a SCI have previously been provided with page of exercises but reported losing it or forgetting what to do despite the picture and written description. They also felt the online diary to be an important aspect to accompany the exercises. Indicative quotes were: “This looks great, I would use it” JP “I don’t like watching the person on the video do stuff that I can’t do so it’s important for the exercises to be tailored for me” JM
“The important part is the diary, physically ticking the box to say that you have done it [the exercise]” RB
Conclusion “It’s simple, easy to follow, you don’t need to be a computer or gadget wizz to use it” JM
• Exercise pages (aerobic, strengthening, stretching and balance), containing a video, text and audio description of the exercise (Figure 1), • Exercise diary, and;
“It wouldn’t be for me as I play [wheelchair] basketball, but it would be good for people who can’t get out or can’t go to the gym” CM
• Advice section Exercises are recorded at different levels of difficulty to be suitable for various levels of ability. Programmes and individual exercises can be progressed remotely. The website has been used with other patients with long-term conditions to good effect1.
“When you are discharged home you feel very alone, isolated, and it’s hard. If I had this it would have been good, there would be continuity in your care when you go home” RB
Purpose The purpose of this project was to develop and coproduce web-based physio for people with SCI and to explore the user perspective.
“[Previously] I was set up with an exercise programme…with pictures and written description of what I had to do. I was finding that even with the photos and the written description I was forgetting what I had to do. But maybe its just me, but its easier if you can follow someone in a video and copy them” JP
Methods A group of specialists (physiotherapists and consultants) and people with SCI were shown the current website and ideas and adaptations in order to customise the website were discussed.
Results
Figure 1. Screen shots of web-based physio exercise videos.
Web-based physio consists of advice and exercises that are suitable for para and tetraplegics. Web-based physio may be acceptable and suitable for people with a SCI whose adherence to PA and exercise is low. Web-based physio may be used in practice to deliver individualised interventions in the community. This would allow people with SCI to complete regular exercise after discharge from specialist units.
References 1. Paul et al. (2014) Clinical Rehabilitation. 28(9): 92435. Acknowledgements This project was funded by the Queen Elizabeth National Spinal Injuries Unit and presented at the WCPT Congress 2015, Singapore. Ethical approval was not required. Contact details Dr Elaine Coulter,
[email protected] @RehabResearchGU
