Background: Increasing referrals to Pelvic Health Physiotherapy Service (PHPS) at Waitematā District Health Board (DHB) for bowel conditions contributed to extended wait times and inequities compared to referrals for bladder or pelvic floor conditions who attended an education class.
Purpose: To assess the feasibility of implementing a Bowel Education Class (BEC) to reduce waiting times for the PHPS at Waitematā DHB and seek feedback on patient experience.
Methods: The BEC was developed in consultation with the multidisciplinary team. Existing PHPS waiting list and incoming referrals were screened by a Senior Pelvic Health Physiotherapist. Inclusion: bowel-related conditions referred from colorectal service. Exclusion: required interpreter, multiple co-morbidities, or combined bowel and bladder issues, patient declined class. Patients were contacted by an administrator and invited to attend. BEC attendees were asked to complete a questionnaire following completion of the 2-part class. Following BEC attendance patients were invited to book an individual PHPT appointment.
Results: BEC ran bimonthly between February and December 2019. 67 patients were invited to attend: 40 attended in-person, 7 attended via telehealth video appointment (70.1% attendance). 94% of attendees agreed or somewhat agreed that class content was relevant and 89% reported their confidence in managing their symptoms as good, very good or excellent. 11 attendees booked 1:1 follow-up with the physiotherapist. Wait times to access physiotherapy service for bowel-related conditions reduced from >9 months <4 months over trial period.
Conclusions: Implementation of the BEC by the PHPS at Waitematā DHB was feasible, well-attended, improved patient confidence in bowel symptom management and improved waiting times.
Implications: Further investigation required on BEC cultural appropriateness, barriers to attendance, and when follow-up 1:1 physiotherapy was not requested. Consider providing access to BEC information earlier in the patient pathway. Opportunities for nationalising BEC in Health NZ including telehealth processes.

Background:
Telerehabilitation may improve accessibility and cost-effectiveness of rehabilitation services but patients’ willingness to engage in telerehabilitation may by influenced by technical or personal factors.
Purpose:
This study aims to explore how patient preferences for telerehabilitation or in-person consultations are influenced by attributes of physiotherapy consultations and patient demographics.
Methods:
A binary discrete choice experiment was utilized. Participants chose between telerehabilitation and in-person consultations across 12 hypothetical scenarios, each with a different combination of attributes related to each choice. The primary outcome measures were attributes related to the choice between telerehabilitation and in-person consultations, namely: appointment duration, cost, travel distance, purpose, therapist, time of day and wait time. Statistical analysis used conditional logit models and demographic data were collected to analyse the impact of these factors on preferences.
Results:
152 participants (76% women; median age of 32) who had attended physiotherapy consultations were recruited for the study. Most (90%) participants were comfortable with technology and primarily used mobile or tablet devices. Patients preferred telerehabilitation when travel distance to the in-person alternative was 20km or 35km relative to 5km, when appointment was 15 minutes, scheduled in the afternoon, or when the wait time was shorter (1 day or 1 week relative to 1 month). Preference for telerehabilitation appointments increased among people in inner regional versus urban areas or with high-speed internet, but was decreased among people with chronic health conditions.
Conclusions:
Preferences for telerehabilitation consultations were higher for shorter sessions where the in-person alternative was some distance away, as well as among patients with high-speed internet, particularly from inner regional areas. Chronic health conditions decreased preference for telerehabilitation.
Implications: These findings offer potential insights for tailoring of physiotherapy service delivery to fit diverse patient preferences to better engage patients and improve care.
[Note this could be moved to a poster if required]

Background: Typically, all patients who have a total knee joint replacement (TKJR) at Te Whatu Ora Waitematā are referred to Physiotherapy for a period of in person postoperative rehabilitation including group based knee class. During the COVID-19 pandemic, this wasn’t possible, and a cohort of patients did not receive any formal, supervised postoperative rehabilitation (no knee class).

Purpose: To assess pain, disability and patient satisfaction ≥ 6 months after surgery in the no knee class cohort compared to a historical cohort of patients who had attended knee classes and had the same outcome measures available.

Methods: Propensity score matching was used to select patients from the historical TKJR cohort that were most similar to patients in the no knee class cohort in terms of age, sex, BMI and number of additional pain sites. Non-parametric ANCOVAs were used to compare WOMAC pain (0-100), WOMAC disability (0-100) and patient satisfaction (1 – very dissatisfied to 5 – very satisfied), between cohorts, with time since surgery (in months) as a covariate.

Results: 36 patients (no knee pain class) were matched 1-to-1 (n=36) from a pool of 74 patients from the historical cohort who completed a minimum of 2 supervised group rehabilitation sessions (median 6, range 2 to 10). All matching variables had standardised mean differences < 0.1 and p-values >0.05, suggesting successful balancing of potential confounding variables between groups. There were no significant differences in WOMAC pain, WOMAC disability or patient satisfaction between the two groups ≥ 6 months after surgery (all p ≥ 0.851).

Conclusions: These findings provide preliminary evidence that failing to attend supervised in-hospital group rehabilitation classes did not adversely affect long term outcomes after TKJR.

Implications: Existing (p)rehabilitation resources may be better targeted to patients at high risk of poor outcome or who are not following expected recovery trajectories.