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Videoconferencing extends
health care to remote patients

Videoconferencing has been used successfully to deliver a physiotherapy rehabilitation programme to a group of patients suffering from a debilitating illness. As well as displaying its green credentials through reducing the environmental impact of travel, the technology proved ideal for delivering health care into a remote area with limited communications and transport infrastructure.

Chronic Obstructive Pulmonary Disease (COPD) includes lung diseases like chronic bronchitis and emphysema, and is one of the most common respiratory diseases in the UK, affecting at least 900,000 people. An effective treatment for COPD is pulmonary rehabilitation, a regime of physical exercise combined witheducation that is usually supervised by a clinician and undertaken as a group-based activity in a hospital or clinic. However, for Scottish patients in the NHS Board area of Highland this is not always viable as they live in mountainous terrain in the largest and most sparsely populated part of the UK, and even patients in urban settings can be put off participating in a programme by location and travel demands. Purely home-based individual training is an option but this lacks the group-based element that characterises a successful programme. Videoconferencing was able to overcome all these obstacles.

The Remote Rehabilitation project is a collaboration between Distance Lab and the Centre for Rural Health, funded by a £63,000 grant from Chest, Heart & Stroke Scotland. Andrea Taylor of Distance Lab says that while the project realised videoconferencing could be used in this situation, they also wanted to run their own software on it in the form of an on-screen timer activated by the physiotherapist. Furthermore, while they had funding, the funding was not large. They therefore did not want a closed or expensive, big budget system.

Informed by previous research and by feedback from a focus group, the project constructed a videoconferencing system that let patients take part in a rehabilitation group from their own home, while still being able to see and speak to the physiotherapist and the other members of the class. For eight weeks, a physiotherapist was able to deliver a pulmonary rehabilitation programme to four users in their own homes in the form of twice-weekly exercise sessions. All participants were visible and audible to each other, all showed clinical improvements comparable to a conventional programme, and satisfaction was high.

The system combined off-the-shelf hardware with commercial and custom software. JANET Videoconferencing enables up to 12 users to dial in to a videoconference from a Windows-enabled desktop or laptop PC. A focus group had identified that many patients, especially older ones, were unfamiliar with the Internet and with videoconferencing: however, the system could be activated by the patients in their own homes simply by pressing a button, after which they were connected to the physical trainer. The commercial and custom software was able to interoperate without difficulty: the image from the timer was simply overlaid on the screen and the other programs, one developed to simplify and automate the process of joining a videoconference and the other to transmit real-time pulse data from the patients to the physiotherapist, operated without interference. Apart a single Internet connection failure for one of the patients, no further problems were encountered in using the videoconferencing system, and even in an area having the slowest broadband speeds in Scotland, the video was satisfactory.

Paul Bonnett, JANET(UK)'s Videoconferencing Technical Co-ordinator, comments: 'We have been working with Content Providers like Distance Lab to reduce the cost and time overhead of providing specialist courses to groups that are often remote or for whom travel poses problems. These groups have found our desktop facility to be a real benefit.'

www.distancelab.org/projects/remote-rehabilitation/

www.ja.net/videoconferencing