'It always works until you go to use it...' Is that just my experience or do other people suffer the same curse. This, I believe, is one of technologies biggest pit falls. The need for charging, cables, sockets, wires, updates, reboots, batteries, connection, connectivity, Wi-Fi, Bluetooth, drivers, codecs, passwords, security, authentication, processors, peripherals and goodness knows what else, other than a user who knows what they are actually doing. The potential for things to go wrong is colossal and I can certainly vouch it, mainly from experience.
Is this its limitation? Is this where the application of technology slows so that the users can catch up, so that the structures needed are developed to be more robust and the knowledge of its availability, application and usage is more commonplace. There is an improving understanding of technology generally, partly because so much of our lives revolve, and sometimes depend, upon it now. Phones, cars, work, smart tv's, fridge-freezers, washing machines etc... But these are fairly common items that most of the population are already familiar with.
Technology is beginning to be a familiar adjunct within physiotherapy. Whether it allows patients to have easy access to their home exercise programme, measure range of movement of a joint using a wearable device or interact with a game via camera or peripheral. It might be an application that measures posture, body markers or gait. Each of these things are all components of physiotherapy that have previously be carried out in a non-technological world, using a non-technical methods and without issue. I say 'non-technical' but that refers to the use of technology to measure the desired function, movement or behaviour, the knowledge required to perform non-technical assessments are of course the same, if not greater in the absence of the technology itself. By trying to utilise technology, are we over complicating the process, the assessment or the interaction!? Are we supressing the need for higher level of understanding and clinical reasoning of the assessment because technology is working for us? And if that is the case, is the potential of technology going wrong the deterrent that means it will, for the foreseeable, be a desirable, rather than an essential, component of active rehabilitation?
There is a price to everything in life, whether it be the time it takes to learn a skill/treatment approach or the cost of technology to assist with performing that skill or treatment. As professionals it is essential to invest in the time to learn the skills and understanding required, so the cost of technology to also perform similar tasks might seem like false economy. Is technologies price tag within rehabilitation an equally important deterrent - something for the rich but not the masses? Who ultimately funds this influx of technology into the rehab sphere, because in the UK services are already stretched with there being limited funding available to afford 'extras'. When discussing funding it could be argued (and has been) that 'wait, surely technology is saving us money now' with telemedicine and remote appointments being more time efficient. Clinicians able to manage time better across increased numbers of patients. Remote monitoring has been reported to save clinic appointment time (REF), with one clinician having the potential to monitor more patients. What happens when remote monitoring goes wrong, when the Wi-Fi goes down or the Bluetooth accidently gets turned off, when the hardware fails to connect or the patient isn't quite sure how its supposed to be used.
What’s wrong with an exercise printout? What’s wrong with a goniometer? What’s wrong with a pen and paper to document the assessment alongside a photo or video (which, whilst these can still be construed as technology, have at least been around for some time). Was life easier without technology? Was it less complicated?
But, technology is here and it’s here to stay. Within rehabilitation technology is either embraced, with attempts to incorporate it within appropriate areas of service and delivery, or it is ignored with the tried and tested approaches and skills of therapists continuing to provide the care and intervention needed.
However, there are many new technologies being developed that have potential to assist with rehab and its right that they should be considered. In my opinion the application of technology within a clinic setting or as part of rehab provision needs to be robustly considered prior to purchasing or implementing. Suggested considerations include:
- The ongoing cost of subscription, setup and upgrades.
- The time taken to upskill and train to use the technology to its fullest potential.
- The interest of the patients/clients - if they aren't keen to use it then it will sit dormant
- The effectiveness of the technology to perform what is appropriate and necessary for the patient. Interventions, no matter how 'cutting edge' still need to be right for the patient
- What the backup plan is for if/when the technology fails
- The set up time of the technology. In a 30min session if it takes 15mins to get to the point where a patient is accessing it, this is not good use of the patients rehab time
- Whether it is accessible to the patients - with considerations including cognition, behaviour, eyesight, movement, body image and general familiarity with technology.
- The longer term maintenance costs as technology progresses - will it need replacing, if so what is its anticipated life span.
It might well sound like I am opposed to the use of technology within rehabilitation - I'm not! Quite the opposite but I do recognise that unless technology is accessible, reliable, affordable, appropriate and used in a timely fashion with the right patients, then it unfortunately has the potential to fail. With failure comes scepticism, reluctance and possible avoidance from the point of view of both professional and patient. Therefore by planning and ensuring the knowledge, the kit and the patient are all aligned, keen and ready to go, technology has the potential to offer positive and interactive experiences for the patients alongside confident and knowledgeable professionals with kit/ platforms that are fit for purpose. The research has already demonstrated that, for example, gaming offers potential for increased adherence to exercise and some areas of rehabilitation, so it stands to reason that as professionals the planning is as robust as it can be to create a productive and enjoyable therapy experience.