Adapting rural physiotherapy placements for COVID-19

Wangaratta District Specialist School (WDSS), located in north-east Victoria,  provides education for around 160 five to 18-year-old special-needs students with various developmental conditions, cognitive and learning delays. In response to an inability to recruit a physiotherapist to their allied health team, WDSS engaged in a collaboration with Going Rural Health, the student placement team from the University of Melbourne University Department of Rural Health, and Charles Sturt University to implement a student-led physiotherapy service delivery model for their students.

A series of eight service learning physiotherapy placements, each involving two students, are planned to run at WDSS from January to December 2020; each building on the work done in previous placements.

The first placement was conducted in person at the school.  After interacting with WDSS students in a range of settings and gaining an in-depth understanding of the school and existing strategies and programs, students identified a need for, and developed, a tailored Hydrotherapy Screening Tool to ensure every student that participated in the hydrotherapy program was safe to enter the water. Individual tailored programs for four high needs classes were also developed. Due to the varying levels of need in these classrooms this combination of individual and group programs will improve the therapeutic benefits of the hydrotherapy program and make it accessible to more students.

A range of recommendations were proposed and will be progressed throughout the subsequent placement cycles, including: developing allied health profiles for the WDSS students, measuring outcomes and functional performance to implement goal setting for the students, developing land based physiotherapy programs,  implementing and evaluating the hydrotherapy program,  documenting changes in outcome measures, goal achievements and functional performance improvements, and assessing the effects of physiotherapy interventions.

Building upon the work already commenced, the second placement was in progress as the unprecedented COVID-19 restrictions unfolded. Mirroring the trends towards telepractice seen in the primary health care sector during this time, staff and students devised and implemented revisions to adapt the student lead physiotherapy program to online delivery.  The second placement shifted to a virtual model mid-placement to ensure the program could continue to provide services to the school and minimise disruptions to the following placements. Stakeholders implemented the following contingencies:

• In alignment with WDSS consent processes, video footage was recorded for ongoing assessment, interpretation and intervention planning in future placements.
• Physiotherapy student presentations were delivered via virtual platforms and recorded to facilitate staff training and implementation of the hydrotherapy program.
• Detailed handover procedures were developed, and recommendations were put in place for future students to complete when COVID-19 restrictions permit.
• Detailed student schedules were disseminated to communicate placement progress, scheduled commitments and occupational health and safety responsibilities.
• Placement objectives and associated deliverables were adapted to accommodate virtual placement models as per relevant policies, procedures and guidelines
• Supervision (including mid and final assessments) and stakeholder engagement and operational meetings were conducted remotely via virtual platforms.

As a result of the above, and as the evidence continues to emerge in this space, virtual placement models are being adopted at WDSS in response to COVID-19, allowing placements to continue with students furthering the recommendations, developing and trialling interventions as limitations permit.

Acknowledging the critical role immersion plays in the recruitment and retention of allied health clinicians to rural Australia, onsite placements will resume at WDSS as restrictions permit. In the meantime, Going Rural Health has adapted outcome measures to evaluate placement experiences and lessons learnt within virtual models.

The commitment and flexibility of school staff and their stakeholders (including supervisors) has ensured this crucial learning opportunity can continue to be provided for the physiotherapy students, while also providing much needed services to the school and rural communities.

The UoM-UDRH gratefully acknowledges Wangaratta District Specialist School, Charles Sturt University, and the Australian Government Department of Health Rural Health Multidisciplinary Training programme.