June 2020 network news

We've launched COVA − our COVID-19 Virtual Assistant, to provide additional support to people with arthritis during the pandemic.

Read more information about COVA.

Led by Dr Jonathan Hill of Keele University and funded by Versus Arthritis, the MSK-Tracker project includes a practical list of MSK self-management resources to help you and people with arthritis.

Read more about the MSK self-management resources.

Our new Arthritis Tracker app enables teens and young adults to rate their arthritis symptoms and gives an overview on sleep, energy levels and activity. It provides summaries for consultations, and helps you, as healthcare professionals, have more productive conversations around treatment and self-management.

Read more about the Arthritis Tracker.

Diarmaid writes:

The use of video technology involves a reframing of the clinical consultation. See it as a virtual home visit, improving the accessibility of your service, not just implementing new technology. It isn’t a replacement for usual face-to-face consultations, but it does offer a unique window into a person’s home and allows a more relaxed clinical encounter.

Three things to do before commencing video consultations

• Watch Trish Greenhalgh’s excellent webinar and guide, Video consultations: how to set them up well, fast? Trish is a GP and Professor of Primary Care Health Sciences at Oxford University.
  All help guides are based on her work including NHSE - Using online consultation in primary care- implementation toolkit.
• Check your local Digital exclusion heat map. Find out if there’s support available in your organisation, useful documents, operating procedures etc. Any issues have most likely been experienced by others and addressed.
• Use Fraser Ferguson’s AHP Scotland infographic as a template of what to do in a consultation during COVID-19.

Then ‘plug in and play’, practising set up and skills with your colleagues. Common platforms Attend Anywhere and ACCURX are very intuitive and user friendly.

What I have learned

• Prepare yourself – check software and hardware before each session, check lighting and no striped shirts! Have a back-up telephone available in case of connection problems.
• Prepare the patient – send out pre-appointment information, check hardware and internet access, have a quiet room with no distractions, remind to dress appropriately, remind to think of ICE (issues, concerns and expectations) and ‘Ask 4 questions’ prior to any consultation.
• Use a structured and scripted introduction – this allows any tech issues to be ironed out, makes the patient more comfortable and frames this as a medical consultation not a zoom chat.
• Consultation – subjective consultation feels more relaxed as the patient is more comfortable. Salient objective tests may be delegated to the patient. They can perform range of movement exercises, dermatomal tests, resisted muscle tests and functional tests guided by the clinician.

We have recently managed patients with a variety of conditions: knee OA − self-care with online ESCAPE-pain programme; Achilles rupture − referred to trauma team; mobility problems − referral to Community Hospital admission avoidance team; suspected CES − referred for urgent MRI and referral for possible metastatic lung cancer.

Virtual consultations can have added benefits for those with long-term conditions such as persistent pain, as they remove the burden of commuting, which can be exhausting. They allow this energy to be focused on what matters to the patient in a more comfortable environment, helping them manage their long-term condition more effectively.

Always remember the patient is inviting you into their home and we as clinicians should be mindful of this, as this platform is here to stay.

We have put together some resources to help both you and people with arthritis. From managing pain at home to COVID-19 guidance for children and teenagers with MSK conditions, click on the links below to browse the list.

• Managing pain at home – Check out these MSK self-management resources supported by NHS England and NHS improvement, together with the BOA, BSR, CSP, Versus Arthritis and ARMA.
• Versus Arthritis clinical assessment of patients with MSK conditions – In case you missed it, we have recently launched a series of new educational resources to give students and clinicians the foundational knowledge and skills in clinical assessment and diagnosis of MSK conditions. These include:
  • a study guide
  • videos focusing on specific conditions, and the routine REMS and GALS examinations.

  You can find out more in our short animated video or by contacting Donna Andrew (d.andrew@versusarthritis.org).

• Free webinar: Supporting rheumatology patients during COVID-19 - This webinar and summary paper address the difficulties faced by GPs in supporting their rheumatology patients during this time. Sign up to hear more about risk stratification, shielding patients on DMARDs, drug dilemmas and ensuring GPs do not miss the ‘golden window’ for referral of inflammatory arthritis. The webinar is free to access but you will need to register for a Red Whale account.
• Active at home: A guide to staying active at home during the coronavirus outbreak - The guide, part of the Sport England Join the Movement campaign, has been developed to support older people and those who are shielded, to stay active and healthy at home.
• RightCare Community Rehabilitation Toolkit – Developed in collaboration with an expert group of stakeholders, this NHS rehabilitation toolkit sets out priorities for community rehabilitation services and the key actions to take. It provides opportunity to assess and benchmark current systems to find areas of improvement.
• COVID-19 guidance for children/teenagers with MSK conditions - CCAA and NHS England have created resources giving advice around young people with MSK conditions during the COVID-19 pandemic.ccaa guide:
  • Shielding guide for children/young people rheumatology patients
  • NHS England: Speciality guidance for clinicians, outlining what constitutes urgent onward referral in relation to MSK conditions.
• Results from the COVID-19 European Patient Registry - Formed by the Juvenile Arthritis Research Project (JAR), the COVID-19 patient registry is a registry of adults with rheumatic diseases, and parents of children with rheumatic diseases, in the setting of the pandemic.