One-to-one physio over Zoom a crucial aid for cystic fibrosis patients

Like many other initiatives, the virtual physiotherapy service for people with cystic fibrosis (CF) had been planned before the Covid-19 pandemic hit Ireland. But the Sláintecare-funded service, initiated by Irene Maguire, senior physiotherapist at Galway University Hospital, has since become a lifeline for those with CF – who have to be extra careful to avoid infections whether there is a pandemic or not.

The one-to-one Zoom calls – which were first offered to adults with CF and are now becoming available to teenagers and children with CF in the Saolta healthcare region (Donegal to Clare including Sligo, Mayo, Galway and Roscommon) – are tailored to individual needs.

“People are more comfortable and confident in their own homes. Most people use it for aerobic or strengthening exercises but we can also do airway-clearance, a review of lung function and remote monitoring of weight, heart rate, oxygen saturation,” explains Maguire.

Sláintecare funding allowed the physiotherapy department at Galway University Hospital to employ Stephen Bradish as an extra senior physiotherapist dedicated to the virtual physiotherapy service, and this position has since been made permanent.

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Given the large geographical area that the hospital serves, not having to attend the hospital for physiotherapy sessions is a big advantage for many people with CF. Maguire cites an example of a teenager boy from Claremorris, Co Mayo, who was previously attending Galway University Hospital for up to three physiotherapy sessions per week. "He saved about €8,000 in travel costs and over 200 hours of his time by attending online sessions, and he build up his capacity and strength through exercises so that he was able to get through his days in college," says Maguire.

'Having the one-to-one zoom sessions with a physiotherapist has been like 'having a personal trainer provided by the HSE'

James, who was diagnosed with CF as a baby and is now in his 30s, says that having the one-to-one zoom sessions with a physiotherapist has been like “having a personal trainer provided by the HSE”.

Prior to these weekly half-hour sessions, his level of exercising oscillated according to how he was feeling. “If you’ve been sick, you’re are less motivated and not able to do as much as you’d like so you lose weight and have reduced lung capacity, which makes it harder to get back to the level you were at.”

‘Strong mindset’

He adds: “It takes a strong mindset to keep at it, but when you can set up a zoom call on your computer on the island in your kitchen and do a 30-minute programme tailored to your level, you can maintain a level of exercise.”

James says that he feels very lucky to have access to the virtual service. “I can see the full body of the physiotherapist on screen and we talk about whether I’m finding the exercises hard or easy and negotiate how much to do. One day I was feeling wrecked and we did yoga. Sometimes, I’m not keen beforehand but I feel the responsibility to turn up and give my best effort in respect to the physiotherapist. I feel like I haven’t gone backwards [in terms of physical exercise] since I started.”

'Even if I'm having a bad day, I can get up and log on to do the exercises and go back to bed if I need to'

Pia who is also in her 30s, says that doing the Zoom sessions has given her a great sense of achievement. “CF hasn’t been that great for me since I hit my 30s. But, working with somebody who understands the needs of my body, my fitness levels, what I am able for and what I am capable of doing, motivates me to do more that I would if I was doing it alone at home.”

She says that she can see steady progress and is building up her strength. “Even if I’m having a bad day, I can get up and log on to do the exercises and go back to bed if I need to. Also, the physiotherapist teaches me exercises that I wouldn’t know, so the variety means I don’t get bored doing them.”

A survey of patients availing of the virtual physiotherapy sessions found that there was a 28 per cent overall improvement in their quality-of-life scores and a 39 per cent improvement on their symptom scores. “We were able to offer 11 times more appointments – because we had an extra funded physiotherapist dedicated to this service and every single scheduled appointment was filled between April 2020 and April 2021,” says Maguire.

Dr Michael O’Mahony, consultant respiratory physician and director of the adult CF unit at Galway University Hospital, adds that another big advantage of regular contact with CF patients via these online physiotherapy sessions is that the physiotherapist can pick up on subtle symptoms changes earlier on.

“It can act as an early warning system and problems can be flagged with the team so that the doctor or CF nurse can review the patient remotely using spirometer (which measures lung function), pulse oximeter (which measures oxygen levels) and a weighing scales connected to a digital app. We can then recommend oral antibiotics if they are needed and monitor the patient over the course of the infection to see if they need intravenous antibiotics.”

Respiratory consultants at Galway University Hospital are now also considering using the virtual physiotherapy sessions as a template for the delivery of other telehealth services to patients with other chronic respiratory conditions.

“It will never replace face-to-face sessions, because we need to see our patients, but a blended model should work well into the future,” says Maguire.