A unique fly-in fly-out partnership is taking specialist physiotherapy services a step closer to Indigenous children living in some of Australia’s most remote communities. It also demonstrates the role physiotherapy can play in delivering outreach, writes Karen Keast.

The tyranny of distance often presents an overwhelming hurdle for many Indigenous families living in Australia’s red, dusty heartland.

But a long-standing collaboration between the Women’s and Children’s Hospital in Adelaide and the Alice Springs Hospital is taking paediatric orthopaedic physiotherapy services much closer to the homes of remote patients and their families.

Under the partnership, a physiotherapy outreach clinic is held at Alice Springs Hospital four times a year with each clinic spanning three days a week.

A senior orthopaedic physiotherapist and orthopaedic surgeon are flown in for each clinic to provide treatment for patients and to also deliver education and training to the Alice Springs generalist physiotherapy team, headed by senior physiotherapist Lenore Block.

Launched about 20 years ago under physiotherapist Helen Burgan and orthopaedic surgeon Dr Bruce Foster AM, the outreach clinic enables many families to access treatment that previously would have required them to travel to Adelaide.

While some patients still fly to Adelaide for major surgeries, the regular access enables the Adelaide team to build better connections with remote patients and their families.

The outreach clinic treats patients with conditions ranging from infections that have affected bones or joints through to trauma as well as congenital conditions such as congenital talipes (club foot) and developmental dysplasia of the hip.

Phil Calvert, the professional lead and physiotherapy manager at Adelaide’s Women’s and Children’s Hospital, has been involved in the pioneering partnership for the past 10 years.

Mr Calvert says the clinic provides a life-changing service for many Indigenous patients and their families.

“We see it regularly where a patient has a diagnosis of club foot and perhaps hasn’t had regular monitoring or therapy,” he says.

“Through our clinic structure and the follow up with the hospital and the local communities, we are able to get an end result for that child which means that they can walk with a flat, straight functional foot that otherwise might really limit their ability to be involved in normal activities in their own community.

“I think the presence of the clinic and the collaboration with the staff at Alice Springs Hospital means that there’s so many of these children who have access to much greater opportunities physically - it really improves their quality of life.”

Mr Calvert, who is also vice president of the Australian Physiotherapy Association (APA), says the clinic sees about 40 patients a day, who live in a one million square kilometre area around Alice Springs.

“Some families and children can travel up to 12 hours just to come into the Alice Springs Hospital for that appointment, so we are seeing children that are living quite remotely,” he says.

“We obviously see a lot of children here (in Adelaide) when they come down for their surgery but one of the great things about the clinic is that we obviously have some continuity with the local staff and those kids back in their own environment when it comes to follow up.

“It reduces the amount of time they need to come to Adelaide for outpatient follow up appointments, so it gives the opportunity for those families to be followed up closer to home with us and the physiotherapists that are going to continue to see them at the hospital.

“It’s a really nice way of maximising continuity of care.”

While the outreach clinic brings access to treatment a lot closer to home for patients and their families, some can still face major challenges when it comes to attending the clinics.

A physiotherapist of 17 years, Mr Calvert says severe weather and a lack of transportation options can result in patients being unable to attend.

“As an example, there might just be one bus that comes into Alice Springs each week from a particular area and the roads are blocked because of weather or the families don’t make the bus and then they can’t attend the clinic,” he says.

“It can mean that their ability to attend regular ongoing treatment can be compromised so there certainly can be some additional challenges around maximising functional outcomes for those kids.”

Under the partnership, the Women’s and Children’s Hospital physiotherapist provides in-service training on topics prioritised by the Alice Springs physiotherapy team.

“With club foot management, we’ve got a number of plastic models that are helpful in teaching serial casting, we’ll bring those up with us and we’ll run a practical workshop for an hour or two on how to effectively cast a baby’s foot and take the staff through that, as an example,” Mr Calvert says.

“A lot of our role involves working closely with the physiotherapy staff from the Alice Springs Hospital with patients who attend the clinic, which is a great opportunity for co-learning and training.”

While the initiative has proven to be a success, the Women’s and Children’s Hospital and the Alice Springs Hospital are considering how they can build on the collaboration and their service to patients.

Mr Calvert says the next step will examine whether telehealth can further increase access and reduce the burden of distance for remote patients.

“For example, there may be a number of patients travelling a long way just to get to the Alice Springs clinic and have a reasonably quick check - for us to let them know everything is going well and we don’t need to see them for another six or 12 months.

“Now that check is still really important but it can be quite brief and I think with those sort of scenarios if we could potentially have those patients somewhere closer to their community with the appropriate technology, whether we can conduct those consults via telehealth, that could again be a really valuable way of increasing families’ ability to attend and participate in the clinic.”

The hospitals will also look into creating an exchange program between the two physiotherapy departments.

The move would enhance paediatric physiotherapy skills for physiotherapy staff at Alice Springs Hospital and broaden the skill set and knowledge of Indigenous and rural health for the Adelaide physiotherapists.

Mr Calvert says the outreach initiative, which receives strong support from orthopaedic surgical staff at both hospitals, is a win for remote patients and also for the physiotherapy profession.

“The clinic also shows that physiotherapists have a really strong skill set in a number of different areas that I think perhaps traditionally haven’t necessarily been identified and could certainly be expanded.

“I think there’s great potential for physiotherapists to have a greater role in leading outreach services to rural and remote areas,” Mr Calvert adds.

“There’s a lot of really good work that already occurs but I think there’s certainly capacity to help increase those types of programs.”