In 2006, the American Physical Therapy Association (APTA) published guidance deeming telehealth “an appropriate model of service delivery” for physical therapy professionals. They also found that it increases access to care for rural populations and people with impaired mobility. So why is it, some 14 years later, the profession hasn’t widely adopted telehealth—even in the face of a global pandemic?
Of course, some activities are more difficult to adapt to a digital format than others—and not everything is suited to be digital forever. Industries like physical therapy that are more hands on are discovering how much of their work can be done virtually—and done well. Physical therapists are finding new, creative ways to use telehealth to continue to provide care to the people who need it most.
Physical Therapy is No Stranger to Telehealth
Although the national focus on telehealth is fairly recent, a lot of practitioners have been studying its efficacy, and actually using it, long before the pandemic hit. This is true for many fields within the health and wellness space—and physical therapy is no exception.
A study done in early 2020 found that when telemedicine was used for at-home rehab after knee surgery, the costs of the rehab went down, and the results were just as effective as in-person visits. The pandemic wasn’t the first time the physical therapy field considered telehealth as a method of service provision. It just wasn’t on the forefront of most providers’ minds like it is now.
How to Operate a Virtual Physical Therapy Practice
That wasn’t the case for Melissa Brown, MPT, DPT, ITPT. She founded her physical therapy practice in December of 2019. Although she didn’t know then what the coming months would look like, she’s unphased by the renewed focus on telehealth. But she does understand why some of her colleagues might be.
“Before the pandemic, I would explain how I would do virtual visits to a lot of my colleagues. It just wouldn’t compute for them because there are some clients where you do really need to be hands-on,” she says. “But now that so many people have been forced into this way of doing physical therapy, they see it works really well. You can get good results without ever being in the same town as your clients.”
Brown admits there are some situations that necessitate in-person evaluation or treatment. In those circumstances, Brown sometimes suggests that her client see a physician if they can. But a lot of the time, she says, there are creative ways physical therapists can offer clients care via telehealth.
“I might pull in a client’s spouse or family member and ask them to do a strength test for me, or help them walk across the room so I can watch,” Brown explains. “I’ll sometimes have a client do a certain movement repeatedly on camera for me, so I can see how their muscles fatigue, or how one side compares to another.”
Increased Emphasis on Communication
Brown believes communication is more important than ever when it comes to virtual care. “So much of what we learn about a client’s injury or impairment comes from really good history taking,” she says. “That’s where I think virtual visits shine. You get to spend a lot of time with your clients and really listen to them, which often leads you right toward a diagnosis before you even start doing other tests.”
As important as conversations between a client and practitioners are, there are still limitations to what a practitioner can learn just by asking. Some clients may struggle to put into words exactly what they’re feeling, or what their home set-up looks like. Telehealth helps alleviate some of those concerns.
“When you’re in a clinic, you can ask your clients ‘Is there a spot in your home where you could do this exercise?’” Brown says. “But when you’re doing a telehealth visit, you can ask them to literally walk you around their home. You can say ‘Can you show me the spot you do your exercises?’ Then you can see what they have to work with. It gives us as practitioners a better understanding of what we can ask our clients to do, and what they’re able to do.”
Although some treatments do require a hand-on approach, telehealth has opened up some new options that didn’t exist before.
“I actually had one client who has access to a pool, so we were able to come up with some water exercises for her to do,” Brown explains. “We had her husband hold her device on the edge of the pool, so I could watch her in the water and say ‘Move your arms this way’ or ‘Go to the shallow end for this one.’ That was so neat because that’s something we wouldn’t have been able to do in a clinic.”
Greater Access to Care for More People
The longer telehealth is the main method of providing care, the more the industry will uncover all of the benefits yet to be discovered. For people in rural communities, people with mobility constraints, and even people with vertigo, online care may be the only way they can access treatment at all.
“I’ve worked with quite a few clients who have vertigo or vestibular issues,” Brown says. “It’s such an ordeal for them to drive themselves to physical therapy when the world is spinning around them. Or some of the tests in a clinic might make you feel nauseous or more dizzy.” For those clients, the option to not have to leave their home and still get treatment is a gamechanger.
Contending with the Future of Care
Physical therapy is one of the fields that might struggle to be permanently remote. As Brown and others have said, some situations do require hands-on treatment. That’s going to be the reality all industries will have to contend with—balancing what can be done virtually, and what needs to be addressed in person.
At the same time, it’s clear that telehealth works—and in some cases, actually works better—for a lot of people. So as the industry tries to figure out a way forward, the argument isn’t that everyone should make a 100% permanent shift to virtual care. Instead, this more flexible model of care should be widely used to improve quality and access to care in a way that makes sense for how people live today.
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