Addressing Complex Needs through Telehealth

Vista Healthcare recently helped a client with complex needs who were looking to improve their quality of life.

This client was only 47 years old but had been living in an aged care facility before recently moving to Supported Independent Living accommodation. Her new home, in Blacktown, was two bedrooms and she shared with another NDIS participant.

Her situation was complex; she was experiencing significant back and neck pain, had limited mobility and was managing an alcohol abuse problem.

Her overarching goals related to engaging with the community again, and as part of this goal, she needed to improve her physical activity and capabilities. Vista Healthcare was engaged to provide Physiotherapy to help with:

  • mobility
  • endurance
  • balance
  • providing recommendations for assistive equipment or additional allied health supports.

Initial Assessment During COVID-19

This was carried out via telehealth due to the current COVID 19 risk. The initial assessment included, among other things, a full musculoskeletal examination covering range of movement of her lumbar spine, lower limb strength and a balance assessment.

Our examination revealed:

  • significant lower back pain
  • very poor balance, creating a significant risk of falls
  • swelling in both ankles, contributing to reduced range of motion
  • lack of movement in her left elbow following a previous break
  • significant deconditioning, plus carrying extra weight, was making walking challenging

Telehealth and Health Technologies

Our Occupational Therapists and Physiotherapists utilised Telehealth to carry out assessments and also to provide demonstrations of the exercises being prescribed.

For example, when assessing range of motion our Physiotherapist could demonstrate how to lean forward, with knees straight, to test movement. The client was then able to mirror that. This was particularly helpful when assessing the client’s elbow injury; careful assessment was necessary as she had a lot of stiffness and could not weight bear with that arm.

Using the Physitrack app with a shared screen was very effective. The client also had a Support Worker who could assist with physical components as needed, so our Physiotherapist could instruct on how to deliver massage for the relief of pain and swelling.

Health visitor and a senior man during home visit. A nurse or a physiotherapist helping a senior man exercise.

Setting Meaningful Goals to Work Towards

While the client’s primary goal was a return to community, sub-goals included reducing lower back pain and increasing the ability to walk independently.

Our recommendations included:

  • regular Physiotherapy including daily exercises (undertaken with the Support Worker)
  • assistive technology in the form of a four-wheel walker

An occupational therapist works with a senior Caucasian woman They are seated at a table and they are doing a fun exercise that involves putting pegs into a plastic board.


The client was hesitant to use a walker, primarily due to her age. She declined initially but we discussed that this was only a short-term measure, and she recognised the many upsides that come with using a walker, such as:

  • greater independence
  • potential for longer outings (because of the built-in seat for rest when needed).

Our Physiotherapist provided training on how to move safely with the walker given that balance, particularly with the potential for alcohol abuse, was a significant consideration.

Other considerations included:

  • weight management, for which we recommended consulting with a dietitian
  • ongoing management of alcohol abuse
  • significant de-motivation which needed to be overcome

Achieving Outcomes to Increase Independence

This client progressed very well towards her goals. She was able to undertake independent outings with her walker, which was her initial goal.

Her independence increased significantly, and we were delighted to hear that she also passed her learner drivers licence test – another great step towards community engagement and an indicator that her motivation was increasing.