The telephone consultation or video consultation in physiotherapy. What should you pay attention to?

Well, is it the ‘new normal’? Telephone contact with your patient, or a consultation by Skype or Zoom?

For the time being.

To have conversations. And be effective in a conversation. That’s what we want.
Offline and online!

Of course, you already know that motivational interviewing is a wonderful approach to coach people, to facilitate adequate self-management and to focus on the person.

But what if you don’t speak to someone face-to-face, but over the phone or via video call? Does it make a difference?
What about the effectiveness of, for example, motivational interviewing?

And what should you pay attention to if you see and/or speak someone virtually?
Because it ís different…. Talking to someone who is physically not in the same room as you are.

Is motivational conversation and coaching of someone via video calling or by telephone just as effective?

That answer may be short: yes it probably is.

Of course, I have not done a systematic review of articles. But the articles I’ve read about it, including a systematic review, indicate that coaching patients on healthy behaviours, such as motivational interviewing, is about as effective as face-to-face contact.

And since we can’t do anything else right now, that’s good to know.

What are do’s and dont’s of physiotherapy via video calling?

What should you pay attention to when doing online consultations?

It seems so simple: you just sit in front of your laptop and start the conversation.

Could be….but maybe it is good to follow some of the tips below.

The preparations – the hardware and you:

  • unfortunately Skype, Facetime and ZOOM aren’t official e-health applications. Better use a privacy-proof app like CGM ELVI
  • make sure the camera you use (probably your laptop) is at your eye level and at arm’s length (or slightly more); so it seems to your patient that yours and his eyes are on the same level
  • your head completely in view, the top of your head just beneath the top of your screen
  • make sure there is enough light on your face from the direction where your camera is (a window without sunlight is ideal; this gives nice diffused light); this way the patient also sees your eyes best
  • light from behind, to the side or – even worse – from below is strongly discouraged as it can make your face hard, unreliable and unfriendly
  • your background is preferably neutral, organized, without moving people or animals (that distracts). Completely white or a different colour is not recommended, it quickly becomes clinical. A neat bookcase, an exercise bike or some exercise materials is fine.
  • what are you wearing? … just like always (and preferably no stripes because that gives all kinds of odd visual effects as if it is moving). Preferably no jewellery… you normally don’t do that in practice.
  • because your laptop is higher than normal, it is useful to have an extra separate keyboard and mouse. The advantage of this is also that the patient is no longer bothered by “drumming” because you are typing.
  • make sure your camera is already on when the patient makes contact; remember that sometimes your patient can see you before you see him (or vice versa) so as soon as your camera is on, make sure to “put on” your professional and friendly look
  • avoid distracting phone calls, no beeps from your email or phone, no background noises from colleagues

Where are you looking at? You might say to the screen? Well no…..

  • you look, no joking, during the conversation as much as possible right ín the camera !! (and not to the video of your patient on your laptop)
  • when you look into the camera, even when the patient is talking, this gives the patient the sense of having eye contact with you. And that is crucial for your role as confident.
  • if you do not look into the camera, the patient always feels that you are looking elsewhere…. (because the patient often does not look into the camera, you may have that idea of ​​him too)

look at the camera of your laptop during the conversation, as much as possible

The conversation itself:

  • if you do not know someone and speak to him for the first time: start the conversation by briefly introducing yourself and also ask the patient to briefly tell something about himself
  • come to an agreement with the patient about how he sees the consultation and how you see it (or in reverse if the patient does not know this immediately).
  • eventually, introduce the software you use and brief the patient about how it works
  • if necessary, consider the security of the application you use; be honest in that (of course).
  • if you record a conversation/consultation, discuss this with the patient first and then start (with permission) the recording
  • if you take notes, tell your patient that you do this
  • pay, more than usual, attention to sufficient silences in the conversation
  • make use of the fact that it is now easier to involve a roommate (if the patient agrees)
  • relax, be friendly, be patient with the patient
  • if you want to provide the patient with reminders during your conversation, share your screen and use PowerPoint slides, for example. You can of course also choose to share your tips/suggestions afterwards by email (if it is not too personal and therefore privacy proof….) or another software solution
  • take a short break before contacting the next patient: close the dossier of your previous patient, relax for a moment and focus on the next contact.

What are the do’s & don’ts of telephone consultations?

What should you pay attention to if you “just” conduct a telephone consultation?

The big difference with video calling is that almost all non-verbal information that you normally perceive is now lost.
Remember that you always use that non-verbal information (it is even very important), but you do this unconsciously.
And that this is also the case for the patient.
Only the voice and words remain.

Non-verbal and verbal, how was that again?
I always say it this way: with the verbal, you convey the content, what you want to say.
Non-verbal determines whether the patient believes what you say. Whether your message has an impact on him.
(and it’s nonsense to divide that into percentages as is often done!)

Specifically, what should you pay attention to when you call someone?
A few tips:

  • Find a quiet environment. If necessary, use a headset, which gives a quieter sound background for you and for the patient. Moreover, it is more relaxed for yourself.
  • Start the conversation with an acquaintance. Then agree with the patient how he sees the consultation and tell how you see it (or in reverse if the patient does not know immediately).
  • Conduct the conversation patiently and in a friendly tone (even if the patient’s dog starts barking again and you can no longer understand the patient)
  • Give the patient sufficient opportunity to have his say; occasionally ask explicitly about things he wants to bring in.
  • Always listen very carefully to the patient; what says its intonation, its speed, it’s timing, etc.
  • Show regularly that you understand the patient by means of so-called reflections.
  • Summarize regularly and ask the patient for additional information
  • Use adequately open questions to encourage the patient to express his ideas and feelings himself
  • Make sure your pace is not too high for the patient. Because you now hardly get any non-verbal information, you may “miss” expressions that may indicate that you are going too fast. And the same can, of course, apply to go too slow.
  • If you are explaining, ask at the end of your explanation if the patient can summarize it in his own words. This ensures that your message has arrived.
  • Of absolute added value is that, prior to your explanation, you ask permission from your patient to explain something. This ensures that the patient is “ready to start” to receive your message.

Well, that was is. Hope you’ve enjoyed it and that it is helpful for you. Thanks for reading!

References

Below are some of the resources I consulted when writing this article.

  • Alexander, G. L., McClure, J. B., Calvi, J. H., Divine, G. W., Stopponi, M. A., Rolnick, S. J., … & Strecher, V. J. (2010). A randomized clinical trial evaluating online interventions to improve fruit and vegetable consumption. American journal of public health, 100(2), 319-326.
  • Bombardier, C. H., Ehde, D. M., Gibbons, L. E., Wadhwani, R., Sullivan, M. D., Rosenberg, D. E., & Kraft, G. H. (2013). Telephone-based physical activity counseling for major depression in people with multiple sclerosis. Journal of consulting and clinical psychology, 81(1), 89.
  • Brown, R. L., Saunders, L. A., Bobula, J. A., Mundt, M. P., & Koch, P. E. (2007). Randomized‐controlled trial of a telephone and mail intervention for alcohol use disorders: three‐month drinking outcomes. Alcoholism: Clinical and Experimental Research, 31(8), 1372-1379.
  • Bus, K., Peyer, K. L., Bai, Y., Ellingson, L. D., & Welk, G. J. (2018). Comparison of in-person and online motivational interviewing–based health coaching. Health promotion practice, 19(4), 513-521.
  • Fougere, Nicole. Top 10 Skype Interview Tips’ by Job Hunt Solutions. As seen on Youtube https://www.youtube.com/watch?v=DwUV-kNPqR8 on April 3th 2020. 
  • Larsen, M. H., Krogstad, A. L., Aas, E., Moum, T., & Wahl, A. K. (2014). A telephone‐based motivational interviewing intervention has positive effects on psoriasis severity and self‐management: a randomized controlled trial. British Journal of Dermatology, 171(6), 1458-1469.
  • Haerter, M., Dirmaier, J., Dwinger, S., Kriston, L., Herbarth, L., Siegmund-Schultze, E., … & Koenig, H. H. (2016). Effectiveness of telephone-based health coaching for patients with chronic conditions: a randomised controlled trial. PloS one, 11(9).
  • Lilienthal, K. R., Pignol, A. E., Holm, J. E., & Vogeltanz-Holm, N. (2014). Telephone-based motivational interviewing to promote physical activity and stage of change progression in older adults. Journal of Aging and Physical Activity, 22(4), 527-535.
  • Lin, C. H., Chiang, S. L., Heitkemper, M. M., Hung, Y. J., Lee, M. S., Tzeng, W. C., & Chiang, L. C. (2016). Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial. International journal of nursing studies, 60, 12-23.
  • Myers, K., Nelson, E. L., Rabinowitz, T., Hilty, D., Baker, D., Barnwell, S. S., … & Comer, J. S. (2017). American telemedicine association practice guidelines for telemental health with children and adolescents. Telemedicine and e-Health, 23(10), 779-804. 
  • Teeter, B. S., & Kavookjian, J. (2014). Telephone-based motivational interviewing for medication adherence: a systematic review. Translational behavioral medicine, 4(4), 372-381.