[Physio Explained] How can we improve access to paediatric physio in rural communities? with Dr Rachel Bican

0:05SPEAKER_01:Families express that they wish it was easier to get to their appointments. And telehealth is one way that we can maybe do that. Some of the other things that I explore as well is community-based interventions. So looking at how PTs can better interact in their communities. Like we run a sports program that is for kids with and without disability at the community center. And we have PT students who go and help so they get hands-on learning time, but also the kids get physical activity.

0:34SPEAKER_00:Welcome to this episode of Physio Explain. Today I'm joined by Dr. Rachel Baikan to discuss how we can optimise rehabilitation delivery and improve access to care for underserved communities. Rachel is an assistant professor in the Department of Physical Therapy at Ohio University and director of the Pediatric Functional Mobility Lab. She is a pediatric physical therapist and rehabilitation researcher whose work focuses on improving rehabilitation delivery and access to care for children with disabilities, particularly those living in rural and underserved communities.

1:08SPEAKER_00:She is also currently leading NIH funded research evaluating telecoaching for caregivers of young children with motor delays in rural communities. In this episode, we explore the gap between the rehabilitation we might ideally recommend and what patients and families can realistically access, considering barriers such as geography, workforce, availability, time and family burden. Importantly, we discussed how these challenges translate internationally and beyond rural healthcare.

1:37SPEAKER_00:Travelling an hour and a half to access care in a remote community may look very different to a parent in an inner city area needing to take three buses with three children, but both can create significant barriers to rehabilitation. Rachel talks us through how approaches such as tele-rehabilitation, caregiver coaching, and community-based care can help us rethink where and how rehabilitation happens rather than simply replicating traditional face-to-face care remotely.

2:04SPEAKER_00:Most importantly, we discuss how we can design rehabilitation around access from the outset, making treatments not only clinically effective but feasible, meaningful, and sustainable for the people and families we're trying to help. I'm James Armstrong and this is Physio Explained. Rachel, welcome to the Physio Explaining podcast. Great to have you on.

2:27SPEAKER_01:Yes, it's great to be here. Thanks for inviting me.

2:29SPEAKER_00:Brilliant. So today we're going to be talking about something that I'm pretty sure all listeners will have had some experience of, whether directly or indirectly, and certainly be aware of some of the inequalities to access of healthcare, particularly for rural and remote areas. And we know that actually you've got some really good knowledge and expertise and very strong interest in how we can maybe develop novel rehabilitation strategies to address some of these.

2:56SPEAKER_00:Talk to us a little bit more. I've done a bit of an intro, but I'm sure you can explain it far better than I can.

3:02SPEAKER_01:My name's Rachel Baikon, and I'm an assistant professor in the Department of Physical Therapy at Ohio University, which is located in the state of Ohio in the United States. Where the university is located is in the region called the Appalachian region. The Appalachian region is a really large region in the United States that follows the Appalachian Mountain region across 13 different states. So very large geographic area. But this area has the some of the poorest health outcomes in all of the United States.

3:33SPEAKER_01:I think only behind or the only place that's behind where they are is the Mississippi Delta. And so working at the university, one of the missions of the university is to address these gaps in rural health care. And specifically, I'm a pediatric physical therapist, and we know that kids who have disabilities need early and often intervention for best motor outcomes. But that can be very challenging from diagnosis to seeing the specialists they need to getting the intervention they need can be really challenging in these rural and medically underserved regions.

4:07SPEAKER_00:Massively, yeah. So we see we see this globally, and this is something that I'm sure can be appreciated across the world in terms of those vastly remote areas.

4:19SPEAKER_01:Yes, I totally agree. And there's a lot of work going on in Australia about this, especially with the tribes that live in Australia and the Aboriginal people. And similarly in the United States, there are these regions like that. And one of one of the distinct things about people in this region is that they take care of themselves and there's some mistrust within the medical system. And so when somebody like me, who I'm not from that region, is coming in and doing research, it is so incredibly important to get buy-in from that community and work directly with members of that community.

5:07SPEAKER_01:So whether that is I have work in Appalachia itself. So I'm partnering with Julia Mazzarella, who's a physical therapist at the University of Montana, and some members of the Crow tribe, which is a Native Indian or Native American tribe in Montana. But it all comes back to there are these specific regions who do not have access to the healthcare that they need and deserve. And that can be particularly harmful for our kids who have disabilities. So partnering with people in that community to come up with new and different ways to address their healthcare needs.

5:44SPEAKER_00:And I suppose I'm going to make a guess partly from some of the notes that we've made prior to this, and also just some thoughts around having to probably extend that beyond traditional modes of rehabilitation that many of our listeners are probably become accustomed to and starting to think, as you say, outside of the box. Is that right?

6:01SPEAKER_01:Yes. So um kind of the first part of the research process that I do is identifying very specific gaps in the healthcare system. And so there's lots of research that says, oh, rural areas, they struggle with transportation or they struggle with like economic resources or health insurance coverage. But when you're talking about a very specific region, transportation is a very big topic, right? And so we go in and we talk to families about specifically what are their needs.

6:29SPEAKER_01:In the region I'm in, transportation is a big issue because oftentimes families might only have one car. And in order to get to their specialists, it's an hour and a half drive, which can be very challenging if you only have one car and the other parent works. And then you get to, oh, the I can wait till after work, but the facility closes. And so when we are looking at addressing those disparities that happen, talking to families gives a really rich kind of context behind not just transportation, but what does transportation, how is that actually preventing coverage or access to healthcare?

7:01SPEAKER_01:And so then taking that information and developing novel rehab interventions and testing those interventions. So, for example, transportation is a big one that we hear a lot. And so, one, I have an NIH funded study right now that's looking at telehab delivery of like a high-intensity PT intervention. And so that takes out the need for the parent to travel, starting from the development of that research idea is families when I was interviewing them before I even had telehealth maybe on the in mind, was families expressed that they wished it was easier to get to their appointments.

7:40SPEAKER_01:And telehealth is one way that we can maybe do that. Some of the other things that I explore as well is community-based interventions. So looking at how PTs can better interact in their communities. Like we run a sports program that is for kids with and without disability at the community center. And we have PT students who go and help. So they get hands-on learning time, but also the kids get physical activity and kind of some eyes on them of well, do they need therapy?

8:06SPEAKER_01:Do they not need therapy? And so that's a way to expand physical activity and potentially like referral practices. And then the other one that I really am passionate about and is built in within all of the things that I do is parent coaching. And so we know, like even in not medically underserved areas, most kids get rehab like once a week. And so once a week for an hour is not enough to cause motor change or neuroplastic changes. And so we really need to work with the family or the caregivers on how do they embed therapeutic opportunities throughout the day to maximize their like therapeutic dose.

8:44SPEAKER_01:And so basically, how do we get the buy-in from the parent and how do we make therapy fun and integrate it throughout the day? How do we make it play? How do we get families excited about doing these things?

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9:33SPEAKER_00:How do you overcome that in some of these really rural, remote locations?

9:37SPEAKER_01:That is a very excellent question. My number one thing is it takes a lot of time. When I got I got to Ohio University in 2021, and I just spent, you know, one of my earliest studies there was like just going and talking to people really and figuring out what they needed. And I have probably been in a hundred homes across like the Appalachian region, just talking to families from there, showing up to community events. My lab has done like volunteer with community, like other community partners.

10:09SPEAKER_01:And from that, like I have been partnered now with the health department and the arts parks and rec department and other departments across the university. And so it really just takes a lot of time and not coming in like you're the expert. I'm an expert in movement and physical therapists are movement experts, but the people that I serve are experts of themselves and their children. And so I try to always approach a research question as what do you need?

10:41SPEAKER_01:And how then can I, as like a scientist, develop a study or develop a program that can address those needs and hopefully find some money to do it. And similarly, you need those people as your stakeholders on your studies. I briefly mentioned some of the work that we're trying to get started in Montana. If you want to do work with Native Americans, you need to have Native Americans on your project. They need to be a part of from the very beginning.

11:09SPEAKER_01:Similar to any grant that I do now, you want those stakeholders to be involved at the development part. And so they're not surprised about what project you're doing or feel taken advantage of. Another really big key aspect is sharing the results with your partners. I think a lot of times university, and not on purpose, but researchers get really busy. And I think they forget to close the loop with those people that they worked with. And so those people feel like they were just used, right?

11:37SPEAKER_01:They were given this thing, they were promised something was gonna happen, and then they never hear about it again. And so I think it's really important to close that loop with anybody that you work with.

11:47SPEAKER_00:It's really interesting to hear you you talk there, Rachel, about uh sitting in front of these sort of these communities and thinking, how can we best develop uh the right approach to rehabilitation to meet the needs of those people? And really, you could argue that stems right back to what we do as individual clinicians with individual patients that are in front of us, but you're taking it to a community level.

12:13SPEAKER_01:Yeah, it a hundred percent. Like you when you sit down and do an evaluation and what are you asking? You're asking, what are your goals? What do you want out of this? Here's what I can bring to the table. And then I need you to collaborate with me so that we have the best outcomes for you as an individual. And we take into account like social determinants of health and we take into account what is going on in that person's life. So you're totally right, is you take that idea and you just take it to the community level.

12:39SPEAKER_00:A different kind of question for you here, Rachel. I said before off air that I'd come up with lots of questions and I definitely have got lots going through my mind. What's going currently? What's going well and what's not going so well? What are your wins and what are the things that you're still challenged with finding difficult to get through?

12:55SPEAKER_01:I think what's going well is that these communities, especially the disability community, are so active and want change. And they are they're a very open group to allow people to come and work with them and advocate for them. And I feel very blessed to be able to work with all the people that I work with. I think the thing that is really challenging is translating research into actual policy change or actual health care change. I don't know where I heard this and I heard it so long ago.

13:32SPEAKER_01:But it takes like 10 years for a research study to be like talked about or implemented. And I feel like it's probably gonna be longer if you're talking about something like a policy change. But at the community level, we can do so much. So it feels impossible to change the healthcare infrastructure. But one of my parents said this one time, and it has really stuck with me. And she's a parent of a child with a disability, lives in a very rural region, and she told me, she's like, I understand that if I move to a city, I'd probably have more resources available to me.

14:03SPEAKER_01:But what is beautiful about where I live is I know my neighbor and we can make the change that I want to see happen in real time. And I feel that in my research is these people are super passionate and they want to make change. And it inspires a lot of like hope in a system that sometimes can feel very fragmented and feel a little bit overwhelming. I obviously am from the US, the healthcare system is very complex, but being able to interact on that more individual basis and make a change in those people, at least who are in front of you and are a part of the research, that is something that goes, I mean, is why I keep doing what I do.

14:36SPEAKER_00:I can imagine it drives you forward when you see those changes come to fruition and the differences it can make to those communities. Yes. Another question, and we are probably going to run out of time quite quickly, but I I think for the listeners listening to this episode, some of them may well be at that point whereby they are trying to make community-level changes and to reach out and access. I mean, I know I'm in the UK with the NHS system. The NHS has been for some time trying to push care to the community, and that obviously has a spectrum of whether that be your community in suburbs in a very busy city, or whether that be far reaching into and out of rural communities.

15:16SPEAKER_00:What would your advice be to those people trying to set up services, trying to understand the needs of maybe more remote communities around them and putting into place something to meet those needs?

15:28SPEAKER_01:You know, we've talked a lot about rural, but understanding that healthcare, health inequities happen in urban settings as well. I use the idea of transportation might be a barrier in both settings. One family has to drive an hour and a half, but somebody who lives downtown might have to take two buses with their three children to get to their medical appointment. And so understanding that these barriers exist and digging into what those barriers are, and then really leveraging the people around you to come up with a solution that is not like one-sided focus.

15:58SPEAKER_01:I think something that I feel a really passionate about is bringing people to the table. You need a really diverse perspective of people at the table, including those who like have the disability, to really get at a solution that might actually work. So, and usually those people are not that hard to find. A lot of these, a lot of these like nonprofits or community partners, they want the help. Um, and they love when people show up and volunteer. And maybe that's where it starts is um, I know some of my stuff started as like kind of like, I'm gonna just volunteer and get to know some people.

16:32SPEAKER_01:Yeah. And those turn into, oh, I know Rachel does this. I'm gonna send you to Rachel, or I know they do this. And so we've kind of have this network of experts across the health, like the health experience. Um, and I don't just work with, you know, pediatric experts, I work with people across the lifespan. Um, and that has been super helpful because we all bring something different to the conversation.

16:55SPEAKER_00:Absolutely. Rachel, as always with this episode, we've run out of time, but I think it'd be really useful for us is how can they find out more about what you're doing at the moment? Where's the best place to sign post them to?

17:05SPEAKER_01:So we have social media. So we are the Pediatric Functional Mobility Lab or the Fun Lab at Ohio University. We are on Instagram and Facebook, but we also you can follow along on the My Like University page as well. So at Ohio University, if you Google Ohio University Rachel Baegan, there'll be some things that pop up about us.

17:22SPEAKER_00:Marvellous. We'll try and pop some links in the show notes. Rachel, it's been a whirlwind, it's been really interesting talking to you, and I feel we've only scratched the surface of some of the things you're doing. And I do think it's incredibly relevant, as we alluded to, whether people are trying to reach communities in inner cities or hundreds of miles into the middle of nowhere. I think it's still relevant, and what you're doing is very important work.

17:42SPEAKER_00:So thank you so much for your time today.