Group Telehealth

• Group exercise can be delivered safely and effectively via telehealth
• Preliminary analysis of a randomized controlled non-inferiority trial comparing GLA:D® delivered by telehealth to in-person GLA:D® in Australia found similar patient outcomes (e.g. pain, quality of life, function) from both delivery modes
• Patients will need:
  • Computer/laptop/tablet with good internet connection
  • Webcam, sound, microphone (usually build into device)
  • Video conferencing software (e.g. Zoom)
  • Space (ideally 3m x 3m, quiet, good lighting)
  • Exercise equipment (can be modified, but ideally physio ball, slider or face cloth, walking pole or broom, resistance bands, chair, step)
• In some cases it may be helpful to have family member assist during the sessions
• Ensure you have a phone number (and emergency contact) for each patient in case of connection issues or other concerns

1) 40m face paced walk test is not required via telehealth (likely not feasible).

2) 30-sec chair stand test can be done. Ensure patient safety by having their chair back against a wall. Be sure to use same chair for pre and post GLA:D®  testing to improve reproducibility.  During the 30 sec test, have the patient also time and count their own repetitions in case of connectivity issues.

During this 1:1 session:

• Ensure the patient is comfortable logging onto the software platform and can operate their technology (e.g. use mute button, adjust camera angles throughout class)
• Discuss tips to improve internet connection
  • reduce internet demand at their house (e.g. ask others to refrain from streaming)
  • decrease the number of browsers or other programs running on device
  • use wired internet in close proximity to a router or modem
  • limit the walls between the device and router or modem
• Discuss patient’s access to equipment (do they have resistance bands, physio ball, etc) or will exercise modifications need to be made
• Check the patients’ environment (e.g. lighting, space, etc) and set up for exercises
• Introduce exercises at appropriate level at assessment so the patient will be more familiar during exercise class. Perhaps consider sharing videos prior to their first class.

• Very little adaptation is needed from in-person education sessions
• Take the time to make each patient feel comfortable in online environment including allowing everyone to do introductions and provide time for questions or discussions throughout session, encourage interactivity of session
• Promote the social aspect of GLA:D® try to facilitate a team environment and build a sense of rapport and trust with all patients.
• You may wish to bring awareness to patients that everyone will be able to see each other during the exercise classes (including inside homes) to ensure everyone is comfortable with this in advance of first exercise session

• At beginning of each class ensure introductions between all participants; make them feel part of a group, stress open communication and that it is okay to ask questions
• Warm up: lots of options for different gait drills, active range of motion, etc
• Be aware that it will take more time for patients to set up their own exercise stations and transition between exercises, especially for first few sessions
• Try moving through stations together as a class. Encourage rest or water breaks for those who finish a station early instead of moving to next exercise.
• Suggest optimal positioning and angles to patients for each exercise so you can best view their exercise technique (coronal or sagittal views)
• Give individualized verbal feedback and encouragement. Be sure to use the individual’s name.
• Correct the exercise technique as best as possible, but also focus on joint loading principles and encourage patients to self-monitor their pain level and to use a diary or log book to keep track of their progress.
• Reinforce key principles from the education sessions during class.
• Periodically check in with each patient.
• Some patients may need extra coaching to encourage proper set up and prompting to adjust camera angles
• Make sure you (the physio) have space to demonstrate exercises and can easily share GLA:D® videos again as needed
• As patients are more comfortable with exercises consider adding music to the class.
• Give patients the option to be muted or unmuted as they are comfortable during the class. This will encourage interaction between patients and it is easier to ensure understanding of the task. If one patient has a lot of background noise you can mute them.

• Consider a cohort style class (rather than rolling recruitment) with all patients starting at the same time
• Limit class size to 4-6 participants maximum