Digital health can help spinal cord injury patients remotely

Case

Digital health & Spinal Cord Injury: Using digital tools for a complex lifetime condition

Professor Anbananden Soopramanien, is a specialist doctor in spinal cord injury and rehabilitation medicine and has been practising in France, Mauritius, several developing nations, as well as the UK, including 3 of the 11 Spinal Cord Injury Centres in the country. After his retirement from the NHS, he is now active in neurological rehabilitation and digital health research, medico-legal work, alongside continuing to provide his specialist knowledge through Premavani, his medical consulting private practice. Dr Soopramanien is using Visiba Care to provide digital pathways to his consultations.

During the entire lifetime of his medical practice, Dr Soopramanien has had an immense interest in digital health. His approach to his spinal cord injury subscribes to a holistic view of care:

My vision is to be able to offer care throughout the journey of the patient – from injury to grave. We need to find new ways of helping patients at all stages of their lives. Which means that when they go home, and they’ve got a problem at night, they can call me us and we’ll be able to help them and deal with their problem. So, I am after a service that would allow us to do that.

Indeed, Dr Soopramanien deems digital health as a valuable tool for that. For this reason, he has been researching the results of remote online health since 2003, in one of the earliest randomised controlled trials carried out in the field of telemedicine (Dallolio et al., 2008). Even with the limited affordances of the technology of the time, the research showed:

Our study, based on results from one site, provided some of the first quantitative evidence, that telemedicine, as compared to standard care, may offer benefits in functional improvement to those discharged from a spinal cord unit.

(Soopramanien et al., 2020)

The realm of spinal cord injury is one of the most challenging in terms of providing care and one of the most complex pathways to care. Patients are first treated acutely, and then attend a rehabilitation centre – a treatment that can unfold for months to come. After discharge, a majority of patients will face a range of concurrent conditions, while also being more physically dependent. Dr Soopramanien has cared for more than 3,000 patients with spinal cord injury and he shares what is frequently the case.

Patients have problems with sensation; they can’t feel, they can’t sit without discomfort, they can’t move easily. They may experience motor paralysis. As a result, their joints become stiff and they get what we call contractures – their joints will be staying in a fixed position and they can’t extend it. It is quite challenging. They’ve got bladder problems, they have problems with their bowels. They can get horrendous pain that they can’t get rid of. Their morale and mood can be very bad.

This complex clinical picture results in lifetime monitoring and frequent contact with healthcare. Nevertheless, and regardless of their clinical needs, it is not always the case that the healthcare system has enough resources to effectively manage spinal cord injury patients from injury to grave. In his latest article, Dr Soopramanien and his research team identified several shortages in spinal cord injury care, among which a shortage of beds and skilled staff, delayed admissions, an increased onset age, shorter stays in rehabilitation, increased rehabilitation costs and a short percentage of integration in the work-life (Soopramanien et al., 2020). Dr Soopramanien tells us what made him turn to see the value digital health can provide:

Say we have 100 patients that were injured and 10 beds. Those 10 get excellent care and many of my colleagues were content. But I got worried about the 90 that never made it to the bed. So, I thought how can I expand the service to the 90? It’s becoming more and more difficult for us to meet our patients on a regular basis, so we need to have another means of doing that and digital health will help because there is shortage of beds, shortage of skilled staff, high costs.

Dr Soopramanien sees several applications and use cases in digital health that extend beyond a single online appointment and transform the entire healthcare chain for spinal cord injury patients as well as healthcare professionals, while also highlighting a critical point: Digital health is not meant to replace face-to-face care.

Digital Health Rehabilitation (that includes telerehabilitation) can be an answer to the myriad of challenges faced by present health and rehabilitation services. It is not designed to replace in-person care but to complement the current system at each stage from prevention to acute and follow-up care, providing smooth and timely access to the specialist input. The technology can also offer training and advice to the professionals, virtual and/or outreach clinics by the multidisciplinary team as well as research and long-term monitoring opportunities. (…) Digital medicine is increasingly empowering individuals to manage their health and wellbeing, transforming the traditional ‘patient-clinician’ relationship. Digital consultations could be an effective way to interact with staff, people with SCI (spinal cord injury) and their relatives at all stages of their journey and follow-up in the community, provide ongoing support, monitor individuals’ progress, and flag early signs of complications thereby reducing readmissions.

(Soopramanien et al., 2020)

During our conversation, he added to the points made in his research:

When a patient, finishes an acute episode and leaves the spinal cord centre, you can use digital health to complement the work that the staff is doing at home. At the unit, the patient’s families would have to travel a lot to visit and when they come, patients may have a rehab session and their families can’t see them. We can have online diaries with the patient schedules, so their families can book a time to visit them.

At times in our unit, when we discharged the patient at home, they may want or need to visit a GP, a physiotherapist, etc to look after them when they come back home. With online, they won’t have to travel all the way. At times the wheelchair is not appropriate, so I can get the occupational therapist, the physiotherapist to participate in a group call and this way the doctor can be assisted by the team.

Dr Soopramanien is putting part of this vision to action with Visiba Care. He is using his virtual clinic for remote assessments, while messages are also available in his virtual clinic. Patients can fill in a pre-consultation questionnaire and upload files and images. When searching for a virtual clinic solution, his requirements included an excellent video quality, good sound quality and no pixelation issues. When asked what he appreciates more in the platform, he listed the calendar view, the ability to exchange files and images, and the appointment administration.

Staying true to a holistic approach, Dr Soopramanien, sees online consultations benefiting the patients, the society, and healthcare professionals alike. He lists:

  • For patients: Ease of access, cost reduction and improved quality of life.
  • For society: Obviously, the environmental aspect is one advantage. Patients and the society overall will be able to have more time, be less upset about the waiting times and the appointments.
  • For clinicians: The satisfaction of being able to operate more quickly and provide better care than in the past.

With a long experience on medical consulting, an ongoing interest in digital developments and a care management approach that places the patients’ utmost wellbeing in the centre, Dr Soopramanien sees digital health in a way that enables healthcare providers to reap the most value: ‘For me, it’s not one or the other – face-to-face or digital; digital is a tool within a toolbox. I think technology will be able to help people across the world and in every area‘. Transforming an entire care management plan is one of the most beneficial visions in digital health and in the ways healthcare can use Visiba Care and we hope his approach is as inspirational to healthcare providers as it is to us.

 

References

Dallolio L., Menarini M., China S., Ventura M., Stainthorpe A., Soopramanien A., Rucci P., Fantini M. P., & Project T. (2008, December). Functional and clinical outcomes of telemedicine in patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 89(12), 2332–2341. 10.1016/j.apmr.2008.06.012 [PubMed: 19061746] [CrossRef: 10.1016/j.apmr.2008.06.012]

Soopramanien, A., Jamwal, S., & Thomas, P. W. (2020). Digital Health Rehabilitation Can Improve Access to Care in Spinal Cord Injury in the UK: A Proposed Solution. International journal of telerehabilitation, 12(1), 3–16. https://doi.org/10.5195/ijt.2020.6312

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