[Interview] Montse Gayoso, Physiotherapist at Hospital Clinic Barcelona

Digital health is already a reality in the health sector. In recent years we have witnessed an important evolution in the world of physiotherapy and rehabilitation, incorporating new techniques and treatments.

We interviewed Montse Nuevo Gayoso, a physiotherapist at the Hospital Clínic in Barcelona, one of the most renowned hospitals in Europe. Currently, with a career of 25 years, she works as a Physiotherapist at the Hospital Clínic Barcelona. For the last 9 years, she has dedicated her work to the Rapid Recovery Fast Track project in Prosthetic Knee Surgery, although she has treated all types of patients with pathology, especially of the musculoskeletal system. Member of the “Grup de Treball de l’Actualització 2019 de la Guia de Prescipció d’Exercicici Física per la Salut” as well as the “Grup de Treball de la GPC sobre osteoporosi i prevenció de fractura per fragilitat” (2013) and the “Grup d’Experts per a definir les característiques del procés d’atenció de Rehabilitació de Malalties del Sistema Nerviós” (2006).

She is also Secretary of the “Societat Cientifica de Fisioteràpia” at the “Acadèmia Ciències Mèdiques i de la Salut de Catalunya i de Balears” and was President of the latter during the years 2008-2016. President of the “Comité Tècnic de Fisioteràpia del Consell Català de Formació Continuada de les Professions Sanitàries” and “Avaluadora” from 2010 to 2018.

What do you think about the benefits that bring technology to the health system?

Currently, thanks to technology, we have acquired new ways of communicating, relating, etc. Anything that can be digital is already being or will be digital. There is no doubt that the health sector could not be left behind, and even less so when we are talking about an improvement, without a doubt, in people’s health.

The greatest beneficiary of the digital age in the health system is the patient. Today I am sure that mHealth helps the patient with active participation in his health process, meaning, we empower him, we give him a more active role.

In addition to achieving this empowerment, the professional can remotely know that his patient is undergoing treatment, network with him to motivate him and increase adherence to therapy, and know that he is doing the whole process correctly so that he can intervene before it could be too late. This technology allows you to connect with the patient and help them to rectify and follow the correct treatment.

Personally, and as a physiotherapist, I believe that telemedicine adds up, and anything that adds up to a patient’s treatment is positive.

What advantages do you think wearable technology offers to rehabilitation?

The patient-technology-professional interaction is very interesting, especially because it gives more precision, more control. Being able to control the patient through a sensor to know if he is doing the exercises, how he performs the movement, at what times of the day he is doing them, knowing if he is following a good pattern, with its corresponding pauses, knowing his heart rate, the steps he is doing, the length of them… and many other aspects that can be achieved, for sure, with this type of technology, makes the functional recovery much more precise and controlled allowing the treatment for each patient in an individualized way to be the right one.

As a physiotherapist, it is essential to follow the entire rehabilitation process?

Undoubtedly, and this is often difficult. Telemedicine, in this case, can be a great solution, since, at present, in hospitals, primary health care centers, mutual insurance companies, etc., it is difficult to have the patient from the moment he or she needs physiotherapy treatment, due to the waiting lists that occur, and also to be with the patient until the whole process of functional recovery is completed.

Thanks to the new technologies, we can manage to attend to our patients, knowing at all times if they are doing a pattern of exercises and how to participate in the improvement of the adherence to the treatment, motivating them to do so by coaching and trying to make them understand the importance of not falling down during the whole process of rehabilitation.

All this in a short space of time. It is well known that the time that can be spent with each patient in the public system or in the different mutual insurance companies is scarce due to the pressure of care. Telemedicine makes it possible to have all the data on the exercises performed by the patient available and to make corrections in a short space of time. This improves the treatment, helps increase their adherence, or simply strengthens them because they are doing everything correctly, making them feel that they are not alone and that they have someone on the other end of the connection from the start of treatment until their full recovery.

What should be the communication between all the professionals involved in rehabilitation therapy? What role can the patient play in this communication?

To begin with, every health professional who has to treat the same patient should speak the “same language” with a common reference. In this way, the person feels treated with understanding.

The way of communicating with the patient is implicit in the way people are, and the empathy is basic, to think about how he feels in that moment to adapt to the maximum to his situation.

Active listening is very important, the patient needs to feel heard.

In physiotherapy, what are the keys to complete and effective therapy?

There is no doubt that physiotherapy has many benefits and brings positive aspects to the health of patients in different ways:

In prevention, improving posture, re-educating different postural behaviors to prevent spinal injuries.
In pain, physiotherapy can help improve and eliminate the symptoms of some pathologies, relieving pain and inflammation in musculoskeletal injuries.
In the management of degenerative diseases, of the musculoskeletal system, neurological, respiratory and cardiovascular, etc., with a preventive and therapeutic approach addressing the physical condition of the patient as well as the management of the consequences of the disease itself.
In the reinforcement of the structures of the musculoskeletal system, improving the mobility of the joints and flexibility, with the consequent prevention of injuries and recovery in case of injuries already established.

In itself, one of the main objectives of physiotherapy is to increase people’s well-being and quality of life.

Sometimes, the treatment requires the hands of the physiotherapist and manual therapy, and on other occasions, once the patient has been assessed, the physiotherapist prescribes a series of exercises to be performed autonomously. It is in these cases where a digital platform such as Rehub shows its effectiveness.

What does the ReHub solution offer professionals and patients?

Rehub is an ideal platform for patients who have musculoskeletal problems, to prevent the progression of the pathology and to prevent future complications, without forgetting the usefulness of Rehub for anyone who wants to perform therapeutic exercises controlled by a professional physiotherapist. The physiotherapist will organize a progressive exercise program adapted to their needs in order to achieve maximum effectiveness without injuries, which is what often happens to people who go to the nearest gym to do a series of exercises that, in most cases, are not suitable for them.

There is currently a great deal of scientific evidence that underlines the importance of therapeutic exercise in people’s health.

If we focus on a person with a certain pathology, Rehub is a great tool for professionals. The professional can check at any time the evolution of the patient or client if he is doing the exercises if he is doing them correctly and thus motivate him both to improve their practice and to congratulate him on the progress made. Rehub allows to observe carefully different aspects of the execution of the exercises but also allows to observe the patient’s work at a glance.

It certainly improves communication between professionals and the patient, because, through the chat, both can connect at any time.

And what does Rehub offer patients?

The first thing that comes to my mind when I think of my patients who have done Rehub is one of the most common comments: “I have someone to congratulate me, encourage me, and rectify me if I do it wrong”. Patients love having a coach; we all need to be looked after, especially when we are going through a recovery process that in many cases is not easy. I treat patients who have had knee prosthesis surgery on a daily basis and they manage to contact their permanent coach, the one on the platform, very positively, but they do not forget that they also have me through a chat room to answer their queries, clarify all their doubts and attend to their proposals. All of this helps in the adherence to the treatment and the empowerment in their recovery process. Another very important point is that they know that, when they are in more pain than usual, we can get in touch with them.

I would say that all this leads to a more important benefit since the patients, feeling accompanied and monitored, will perform the exercise pattern correctly and, therefore, recover sooner.

How important is it to measure patients’ adherence to treatment as performed by ReHub?

Adherence to treatment is influenced by the patient’s state of motivation, their situation – not pleasant because they are going through a difficult time in their health – understanding the instructions given, incompatibility between activities of daily living (ADLs) and their condition, their personal history, and their acceptance of the effort they have to make, the confrontation of the pain that you are experiencing in your post-operative period, including your beliefs, if your recovery work is really necessary once the prosthesis is implanted,… All of this often makes it difficult for patients to carry out the guideline that they should in order to obtain a good functioning of their prosthesis.

For all the experience I have accumulated both in patients in the post-operative phase and at home, I can assure you that adherence to physiotherapy treatment is sometimes a complicated challenge.

Finding fully adherent patients with sufficient willpower to perform physiotherapy exercises autonomously is difficult, they are a minority.

When the patient is in the immediate postoperative period, for example, those who have undergone knee surgery, with their pain, their edema, their swelling, their bruises, etc., it seems that they find sufficient excuse to leave some of the scheduled sessions during the day (sometimes all of them) and we know how important it is at this precise moment to carry out the entire physiotherapy guideline to help improve all the symptoms I have talked about.

Also, when several days go by and they feel better, they find again the perfect excuse to deceive themselves and decide that, since they are better, why do the whole pattern, even reaching the case that some patients, if they are active, decide to return to work.

Both moments are crucial for the good evolution of the process they have gone through; once the surgery has been performed, the most important thing is the process of functional recovery, good muscular reinforcement, achieving all the range of movement that the new joint can offer, making a good walking pattern, adapting the knee to daily life activities, etc.

Without a doubt, patient adherence is important, and in this case, ReHub is especially helpful.

Without good adherence, the patient loses and the economic and social cost increases, given that possibly, this arthroplasty, if the patient does not collaborate as necessary, could lead to possible complications in the future.

Would you recommend the use of digital platforms to hospitals?

Of course, it can be a good tool to add to the specific treatment by the physical therapist. We must never forget the need, in many cases, for manual therapy by the physiotherapist. But in addition, a programmed exercise such as that carried out by ReHub could mean that, in a physiotherapy center, for example, the physiotherapist could be carrying out good manual therapy, whilst his other patients are carrying out an individualized exercise program, confident that they are doing it correctly.

What do you think physical therapy will look like in the future?

I hope and wish that with the new technologies we can all make much more objective assessments in terms of joint and muscle balance, and even evaluate parameters that are not possible manually, such as the speed and quality of each of the exercises.

It is also important to be able to supervise patients until the end of their functional recovery and to be able to prescribe different exercises to be performed from the beginning of their treatment until their total recovery. And beyond that, to get the patient to understand the importance of movement, the importance of exercise and to have people, and not just patients, who ask to do a healthy exercise pattern without possible injury from malpractice.

Interviews