PhysioUpdate Supplier News 6th July 2023

Zubair Haleem is a Specialist Physiotherapist with over a decade of experience in professional sport, research and outpatient musculoskeletal physiotherapy. He is currently a Senior Academy Physiotherapist at Arsenal F.C., a Senior Research Physiotherapist at Queen Mary University (London) and the Tendon clinic lead at Barts Health (NHS Trust).   

We recently caught up with him to learn about how he’s bringing his experience with managing and rehabilitating elite athletes at Arsenal F.C. using VALD’s objective measurement technology to the NHS.  

Why is using objective measurement technology important?

One of the goals during rehabilitation is to return the patient to their optimal strength following injury, however it can be difficult to assess whether you are objectively meeting your targets. In clinic, we often prescribe ‘strengthening’ exercises but can fail to objectively measure whether our plans have resulted in any meaningful changes. Over the years, smaller handheld dynamometers have been developed to bridge the gap however the ability to track changes over time with automated analysis remained limited.

Is there a difference in how you use the systems between elite sport and community rehab?   

We utilise these systems daily within an elite sports setting, alongside measures of wellness. We measure isometric peak force, jump height and rate of force development (RFD) within the fit squad to monitor fatigue, responses to previous sessions and readiness to train.  

In a rehab setting, based on the stage of rehabilitation there may be a focus on a particular output such as eccentric strength or reactive strength index (RSI) that can be easily assessed. Rehabilitation can be progressed or regressed based on these findings in conjunction with other clinical markers.

What is the benefit of using VALD technology with general population?

I feel the use of VALD systems has enhanced my clinical practice within the NHS. Providing patients with a baseline, identifying deficits, implementing specific exercise plans through TeleHab and then re-testing objective measures alongside digital PROMs  assists in streamlining processes and service delivery. 

Patients are now increasingly using technology to enhance their own health and wellbeing. The data visualisation provided by VALD systems can be easily understood by patients and clinicians. The data collected can also help me identify patterns amongst groups in my patient demographic which helps inform service developments

What type of patients or clinical presentations do you use these systems with?

I run a complex rehab and tendon clinic within the NHS, the aim of which is to:

1.                    confirm diagnosis where possible;
2.                    ensure rehabilitation has been optimised; and 
3.                    consider alternative treatment strategies. 

I believe some level of testing and monitoring is indicated for the majority of patients to guide rehabilitation, regardless of diagnosis or joint involvement, and I have used VALD systems for patients with both upper and lower limb complaints. 

In the absence of a definitive diagnosis, it can be important to identify areas to work on (or not to work on) if objective measures suggest they have suitable strength compared to normative data. For example, I would typically profile a patient with a lower limb complaint using the following tests:

•    Hip abduction/adduction (ForceFrame);
•    Knee flexion/extension (DynaMo);
•    Ankle plantar flexion (ForceFrame); and
•    Jump testing on ForceDecks, where appropriate.

What are the general key metrics you look at:

It can be easy to get carried away with the data, and therefore clinical reasoning is always imperative. Some examples:

• Acute stage rehabilitation: I may complete sub-maximal isometric training in a pain-free, safe range to maintain function and reduce atrophy.

• End-stage shoulder rehabilitation: I may use peak isometric force of external rotation in a overhead position or look at rate of force development in an I-Y-T ASH test protocol. 
• A runner with achilles tendinopathy: I may look at double or single-legged plyometric movements on ForceDecks, with attention to jump height, peak landing forces, side-to-side asymmetries, reactive strength or ground contact times. Deficiencies in any of these metrics can prompt me to make adaptations to plans.

Has VALD technology impacted your clinical decision making?

The core key principles of physiotherapy assessments shouldn’t change. A thorough subjective examination, listening to the patient’s thoughts, beliefs and expectations alongside a comprehensive objective examination should result in a sound understanding of the person.  

However, we know that the inter-rater and intra-rater reliability of traditional manual muscle and ROM testing can be poor. Therefore, standardising testing with accurate measures – saved straight to a patient profile – can improve reliability and the service provided. I feel the use of the equipment provides me with a better understanding of patients’ capabilities, which then allows us to make informed, collaborative decisions together.

How do you incorporate these systems into your clinical workflow? 

The plans we have start with a link to VALD systems, which we created within our existing NHS CRS system. This should allow for patient’s testing, home exercise programmes and PROMs to be easily accessible alongside the patient’s medical notes and records in one central location.  

In a busy NHS clinic, it’s essential to streamline processes for efficient use of time. The data storage and visualisation within VALD hub does most of the hard work for our team and allows us to maximise clinical time with the patient.