WebRTC makes a splash at physiotherapy conference

WebRTC technology was used to beam in two UK-based physiotherapy researchers to the recent Australian Physiotherapy Association (APA) conference, fittingly to discuss the use of telehealth for physiotherapy.

WebRTC is a draft web standard for real-time video, audio and data communication between web browsers that is expected to be ratified soon by internet standards bodies. It is being looked at closely for telehealth provision as it is free, easy to use and has the potential for secure file transfer and sharing of images and documents.

During a presentation in a telephysiotherapy session at the conference explaining the methodologies, outcomes and cost-effectiveness of telephone-based coaching used with decision-support software, UK researchers Jill Gamlin and Annette Bishop conducted a three-way video call with session moderator Ross Iles in Melbourne using WebRTC.

The presentation lasted one hour and despite latency of 380 milliseconds, poor bandwidth at one site and wireless internet at the other, the conference call did not experience any problems such as dropped connections or echo.

It was conducted through Google Chrome and only required a normal laptop and internet connection. In a similar way as jpeg and mpeg allows the exchange of pictures and movies, WebRTC enables the exchange of live video communications.

Dr Iles, a lecturer in physiotherapy at Monash University, said the benefits of WebRTC were that you don't require high-speed internet connections or that the person at the other end install software.

“We wanted to demonstrate what the possibilities are, because the aim of the conference was to say, this is the technology that is available, what are we going to have to do differently to make the most of it?” he said.

The UK speakers discussed PhysioDirect, a physiotherapy-led telephone assessment and advice service run by Huntingdonshire Primary Care Trust that serves 350,000 people in Cambridgeshire.

The organisation has set up a computerised system that in effect triages patients and guides the physiotherapist in whether to refer to a hospital or GP, a face-to-face appointment with a physio for assessment or a home exercise regime.

Dr Iles said similar services for physiotherapy in Australia were rare. “There are different telephone-based services around but nothing that has been researched to the extent that PhysioDirect has in terms of being able to provide data and outcomes and cost effectiveness,” he said.

One Australian research project that has been assessed is the University of Queensland's work in telehealth-based rehabilitation. The co-director of UQ's Telerehabilitation Research Unit, Trevor Russell, whom Dr Iles described as a leader of telephysiotherapy in Australia, explained his work on video-based postoperative rehabilitation.

Dr Russell is the creator of the eHAB software solution, a mobile, multi-media video conferencing system that enables telerehabilitation consultations in the home. It is being used for speech therapy and audiology as well as physiotherapy.

Dr Iles said the telephysiotherapy session at the conference was about how physiotherapists could think differently when they were not able to do hands-on treatment. While WebRTC probably wouldn't put an end to personal visits from international speakers, it is one of a range of technologies that can be used to help healthcare professionals to think differently.

“What we aimed to draw out at the conference was how do we think differently when we can't put our hands on [patients],” Dr Iles said. “But with clear communication and instruction, there is research to suggest we can diagnose and treat just as well via video as we can in person.”

The APA conference, held earlier this month, also featured an app for attendees through which they could access the program and speaker bios and send emails.

Posted in Allied Health


0 # timothy holborn 2013-10-24 14:59
720p connections require about 1.5Mbps of bandwidth. The way the video is encoded, is through a technology of compression embodied as a "codec". The "codecs" used by WebRTC are similar to those used by skype. Clinical Telehealth is considered to require high-quality video, at reasonable frame-rate. The problem isn't the "download" capacity, it's the "upload" capacity and the ability to sustain the bandwidth throughout the duration of the call. WebRTC is a fantastic technology, but the bandwidth limitations still exist regardless due specifically to the CODEC technologies used.

In terms of "coverage" (the most important part of "telehealth), being the ability to provide it to remote, rural or regional locations; Satellite systems are being developed with Activ8me that are capable of providing this bandwidth requirement. Latency isn't so much of a problem, although it does take about 600 milliseconds to travel back/forth from space, to areas otherwise unable to connect to suitable connectivity. In metro areas, SHDSL provides bandwidth capabilities; and in-order for these clinical grade systems to work, connectivity needs to be suitably provided at both ends of the conversation.

beyond these basic aspects of realtime communications technologies; clinical requirements may in future consider eye contact, supportive of non-verbal cues and related behavioural considerations overall. The reality is, however, is that implementations will be different in how these systems are implemented for clinical environments vs. clinical to home environments . SIP, a technology used for internet based telephone calls, has the capacity to support video conferencing on secure sip to sip connections, as well as providing WebRTC interfaces for participants.

The technologies used for TeleHealth are the same as have been developed for a myriad of other applications, such as Video On Demand and Live Streaming of events, etc.

To suggest that implementation of a clinical grade solution can be free - is a little misleading, and overall not in the interests of patients, practitioners or the effective uptake, training and utilisation of this new clinical medium for remote health services overall. Medicare could, or perhaps should play a role, in establishing secure telehealth service access and billing methods for the industry as a whole using secure SIP services. In future, I believe the internet telephone enable "numbers" (using sip) will support secure video call functionality. The problem right now, is ensuring people can communicate to each-other, and understand the importance of implementing an appropriate solution as to afford themselves, and their patients, a clinical expectation of tele-health services.

ADSL, ADSL2+ for example cannot provide more than 1Mbps upload (sending to somewhere); when that connection is then shared in a home or office / clinical environment,

it's simply inaccurate to suggest clinical grade telehealth can be implemented freely, using a webpage for the majority of clinicians. Something is better than nothing, but modern society rejected "witch doctors" some-time ago, and the medical industry has always faced challenges in the same philosophical light, when considering the use of funds on technology and internet. on the ranzcp website, they have Technical specifications for telepsychiatry - and you can note the statements relating to high-definition requirements of 2Mbps bandwidth. Here's a link: http://bit.ly/Hg3t8R
0 # Hubi 2013-10-25 15:02
webRTC is flawed should really not move beyond draft release.

Google, Mozilla and other supporters of the current IETF WebRTC standard need to *prove* that cross-browser development of web-apps is not just feasible, but easy.

0 # Warren Mc 2013-11-06 12:31
Most technology standards are flawed in some way, and are open to improvement. The proposals from Microsoft and the new Object RTC group, provide an alternative lower level API that "could" implement interoperabilit y with current WebRTC draft standard with an additional javascript library.

Despite the normal historical activity of competing standards development and various levels of browser adoption, the important thing here is that the basics of browser based real time video communications have now been established to the point where they can used on a daily basis.

Regarding the uplink bandwidth requirement for HD use, yes WebRTC is no different than other technologies. The take away should be that investment decisions about software and services are about to change dramatically, in a way that will remove barriers to Telehealth uptake.
0 # Mukul Jain 2013-11-29 03:44
I am in agree with some of the comments above.

I am a 100% supporter of webRTC, its advancement, and the fact that it will make video communication more pervasive but to say that it is a breakthrough technology and creates a splash at telehealth industry is far from truth. There is nothing fundamentally new about this technology which was not available to the industry such as TeleHealth. Even today there are solution available and have been there for more than 5-6 years in production. Also industry like TeleHealth wont run free technologies like this it needs a much more sophisticated system to thrive on.
WebRTC shall provide a more pervasive video communication - easy to use and available everywhere. Other than that there is a much more hype and it is been seen bigger than it is.

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