Table 3

Factors that may affect patient preference for virtual consultations and considerations for virtual consultations

FindingConstructResults from included papers: factors that contribute towards the work of being a patient when using communication technologyConsiderations for virtual consultations
Preferences are shaped by the requirements of the consultation how these change the workThe processes that changePatients were able to engage in consultation from different places.6 Using virtual consultations required patients to arrange for additional equipment in the home.23 They were required to log in to an account28 and to learn how to use the communication technology.6
  • Consider the impact of changing processes on patients.

  • Offer troubleshooting for logging in and how to use the equipment.

  • Consider offering guidance surrounding the suitability of different locations when engaging in virtual consultations.

The skills and expertise that is requiredAs patients moved away from physically facilitated exercises, there was the requirement to adjust,27 overcome patient–clinician communication difficulties over video call24 26 and phone call25 and face an increased reliance on them to communicate information.6 In the absence of hands-on treatment, more emphasis is placed on patients completing exercises.6 Patients need to self-assess when they cannot be physically assessed by a therapist.6 Patients may need to adapt to clinicians who do not have adequate communication skills or training for using virtual consultations.22 Patients may be encouraged to self-monitor improvements more than if they were seen face to face.25
  • Brief and support patients on the changes in style of communication.

  • Facilitate patients to communicate their problems through a virtual consultation.

  • Facilitate self-assessment of patients in the absence of clinician’s ‘hands-on’ care.

  • Facilitate and provide guidance on self-assessment and ongoing monitoring.

  • Design personalised exercise regimens that are suitable for the patient’s clinical problem and their home environment.

Preferences are shaped by the resources that are required for patientsLogisticsUse of virtual consultations helps to avoid transportation issues,6 16 22 23 27 28 reduces travel times28 for both patients and carers and can increase access to services.6
  • Consider offering virtual consultations for patients who experience difficulty with travel.

TimeThe ease in which exercises can be integrated into home routine16 28 and through avoidance of travel provides additional time and energy for other activities.27 Patients valued being able to wait for their appointment in their own chosen environment rather than in the clinic.6 25 26
  • Consider conflicting demands for patients.

  • Consider the impact of travel and time on patient symptoms.

  • Consider the impact of patient comfort when waiting for their appointment.

Preferences are shaped by the work required due to the changes in the environmentSetting for physical rehabilitationPatients had to find ways to overcome a lack of space6 28 and equipment6 23 at home. Patients were required to integrate their rehabilitation in the home environment.6 22
  • Support patients to establish a suitable rehabilitation environment at home.

  • Design treatment regimens based on the patients access to rehabilitation equipment.

  • Support patients to integrate rehabilitation within the home environment.

Setting for virtual consultationAt times the rehab was impaired due to technical difficulties6 and patients felt they missed learning through fellow sufferer contact through not attending the clinic and would need to seek this elsewhere.28
  • Offer troubleshooting when faced with technical difficulties.

  • Consider offering peer support groups for patients who are unable to physically attend the clinic.

Hardware and softwarePatients needed to be supported to access6 23 and use the equipment6 16 24 28 and manage to real-time troubleshoot connection problems as they arose.6 23 24 27
  • Consider offering equipment based on the patient’s needs.

  • Tailor support for equipment use based on patient’s skill set.

  • Offer troubleshooting when faced with technical difficulties.

Preferences are shaped by the work that goes into maintaining adequate interactionsInteractionsPatients may have to focus additional attention when communicating over a stutter connection6 27 or when faced with a language barrier.24 Patients may need to rely on additional non-verbal communication when communicating over a screen.26 Patients who feel alienated28 or detached25 28 or expect hands-on care6 24 25 may need to invest additional effort in developing an effective therapeutic the patient clinician relationship.
  • Clearly communicate when the connection is impaired; be prepared to abandon and reboot the virtual consultation as required.

  • Be prepared to emphasise the use of non-verbal communication.

  • Have an awareness of patient preferences; patients who prefer face-to-face care may require additional input to develop a therapeutic relationship.