Home programme and remote follow-up

The gains from an intensive rehabilitation block fade without a maintained programme. For international patients this is the largest single risk to the whole investment, and it is the part most often left to chance.

So the home programme is designed before discharge, taught until it is being performed correctly, written down with images, and followed up on a schedule rather than left open.

Scheduled video consultations at agreed intervals, in which the exercises are observed and corrected and the programme is progressed. Between them, sensor-based or app-based recording where appropriate, so adherence and technique are visible rather than self-reported.

Progression is the point. A home programme that never changes stops producing gains, because the body adapts to it.

Patients returning home after an intensive block. Patients who cannot travel for regular appointments. Patients between blocks in a repeated programme, particularly children, where the interval work determines what the next block can build on.

It is also used for patients considering travelling to us, as a way of starting properly before arrival.

Hands-on assessment, manual treatment, and anything requiring equipment. Remote follow-up supports and progresses a programme; it does not substitute for the in-person work that established it.

Where we think a problem needs in-person assessment, we will say so rather than continue remotely because it is convenient.

The exercises are watched rather than asked about, because technique drifts and a programme done incorrectly stops working. Progression is set, load is adjusted, and problems that have appeared since discharge are addressed.

Measurements that can be taken at home — walking distance, chair-rise time, range at a joint — are recorded so that change is tracked rather than estimated.

Where hands-on assessment is needed, where a new symptom suggests something that requires examination, or where progress has stopped and the reason is not visible on video. In those cases we say so and recommend local assessment.

Video review is a genuine tool and it has limits. Presenting it as equivalent to in-person care would be dishonest and would delay problems that need looking at.

For some purposes it appears to. A systematic review of 13 studies with 1,520 people with musculoskeletal conditions found that treatment delivered entirely by real-time video improved physical function about as much as face-to-face care, with comparable pain relief 1. After stroke, a Cochrane review of 22 trials found no difference between telerehabilitation and in-person therapy for daily activities or balance, although those comparisons were small and the evidence was of low quality 2.

The same Cochrane review found moderate-quality evidence that remote support programmes added after hospital discharge did not improve independence in daily activities compared with usual care 2. Its authors note that few trials were adequately powered and that the field is still emerging, so these conclusions may change 2.