The year 2020 has been a crazy one!  The novel coronavirus Covid-19 has completely changed how we all live, work, and enjoy friends and family.  It has already had a profound impact on healthcare and by this point I think we all realize our lives will never be the same.  The rise of telehealth, also called telemedicine, is an inevitable consequence of a world where the dangers of contagious disease are front and center.  Every time we leave our home, we put ourselves at risk and while this may have been true prior to this pandemic, we are more aware of this danger and are making changes to our daily routines and medical care is no exception.

This is the time to embrace telehealth as the next frontier of healthcare and how it will benefit your life going forward.  Telehealth brings with it many advantages over traditional healthcare and most vital is the ability to recover from disease or injury without exposing yourself to other contagions and adverse events.  In this article I am going to answer some of the basic questions of telehealth physical therapy.  What it is, how it works, as well as benefits and drawbacks of online physical therapy rehabilitation.  So, let’s get started.

  1. What is telehealth or online physical therapy?
    1. Physical therapy is the treatment of injury or disease through the use of education, physical treatment, and exercise versus drugs or surgery.
    2. Telehealth or online physical therapy is the use of various methods of teleconference between a patient and a physical therapist in which to educate and guide the patient through self-treatment via exercise, lifestyle changes, and instrument assisted manual therapy.
  2. How is telehealth physical therapy performed?
    1. Live (synchronous video) – Live video conferencing using secure mobile software that allows for the patient and clinician to work together in “real time”.  This is just like an in-person session in that they tend to last a similar length of time as in-person therapy and feedback is given and received during the therapeutic session.
    2. Store-and-forward – This is an asynchronous format that is only allowed in some states.  The physical therapist prepares their instruction and education beforehand and sends it to the patient via video or audio.  The patient accesses this information and performs the treatment on their own time.  Often the patient then records themselves performing the session and sends this in to the clinician, who can then review the video and give feedback to the patient.
    3. Remote Patient Monitoring – This involves a device that the patient has on their body usually all the time.  Like an Apple watch or Fitbit, this device tracks certain health data and reports it back to the clinician at a set time period.  The clinician then can ensure that the patient is following the assigned protocol, as well as is aware of adverse events if they occur.
    4. Mobile Health – This is usually an application for phone or computer that helps to setup an exercise or rehabilitation plan.  You then follow the plan via the application which guides your progression.  Often daily alerts are given, and patients and the application can ask for patients to report data for accountability.
  3. What are the benefits of telehealth physical therapy?
    1. Telehealth physical therapy allows you to avoid exposing yourself to other illness by performing your session in your home, work, or wherever you like.
    2. Online physical therapy is convenient, there is no commute, no waiting room, meaning a 30-minute appointment lasts exactly 30 minutes getting you back to work or life without costing you extra time.  If time is money, then telehealth physical therapy saves you both.
    3. Patients are more active participants in telehealth physical therapy.  Medical practitioners know that the key factor to patients recovering is adherence to the protocol they have designed for the patient.  With telehealth, the physical therapist can design a program based upon your environment and tools you have at home or work.  Psychologically your home or work environment becomes your physical therapy clinic, meaning you are more likely to keep up with your therapeutic protocol and thus more likely to have better outcomes.
    4. Online physical therapy is one on one.  How often does your physical therapist have another patient or two that they are treating at the same time they treat you.  Quite often.  With telehealth, all attention is one each individual patient for the duration of the treatment session.  Physical therapists are able give better and more complete patient education and feedback in less time.  You won’t be waiting around for the next exercise or spending 30 minutes on an exercise bike, unless that is specifically what you need for your recovery at this time.
    5. You have access to every practitioner licensed in your state.  This means you can be treated via telehealth by the specialist expert whose clinic is five hours commute from you just the same as the local clinician that is fifteen minutes away.  If you need specialist care to return to higher than average physical demands like CrossFit or the police force you can find a specialist with a background in treating patients with higher physical demands.  If you need specialized care for incontinence or painful intercourse, you can find a specialist that treats this specific need, even if they are not in your city.
  4. What are the drawbacks of online physical therapy?
    1. The most obvious is that the patient cannot be “hands on” with the patient.  Examination and treatment will need to utilize the clinician’s ability to evaluate movement via carefully watching patient movement and posture and by gathering vital information through interviewing the patient.  Manual therapy will need to be performed via instruments such as a lacrosse ball or pulleys.
    2. Some patients and physical therapists will find the use of the technology involved in telehealth to be a challenge.  Patients and physical therapists will need to be educated on how to properly setup a space for teletherapy and how to use and what software is secure to keep the session private.  The key is education, patients should receive education on what to expect and how-to setup their connection and space prior to the first session.  Physical therapists must seek training and educate themselves on how to adapt their evaluative and therapeutic methods for use on a teleconference platform.
    3. It’s not “in-person”.  Even with futuristic teleconference technology that is straight from “The Jetson’s”, online physical therapy lacks the personal connection of in-person care.  For most patients, a combination of telehealth and in-person care will be optimal for their rehabilitation.  However, in the case that an entire bout of care takes place via telehealth patients and physical therapists will need to learn to connect in new ways through the use of technology.  Often, clinicians are open to a stream of text messaging between patient and the clinician for anything that comes up and just to keep the patient motivated.  Patients may desire to spend some sessions just connecting on a personal level versus performing treatment every time.  Many patients and practitioners have found telehealth to be an incredible medium for keeping closer contact with patients during the interim between in-person care, and often the use of telehealth technology leads to more open communication between the therapist and patient in-between appointments.
    4. Telehealth is not right for every patient.  One of the most important skills of an expert telehealth practitioner is the ability to triage patients that are appropriate for online physical therapy care.  Many patients will require in-person care for safety or to ensure the efficacy of treatment.  However, most patients will find that even injury and disease that seem at the outset as a poor fit for telehealth will in the end see outstanding outcomes of recovery online.

Telehealth or online physical therapy is one of the latest innovations in healthcare that is here to stay.  It brings with it quite a few benefits to patients as well as clinicians.  Current research supports the efficacy of telehealth physical therapy finding it as effective as traditional in-person care.  This research comes from diverse sources such as University of California Irvine School of Medicine, to Mani et al., to Duke University Rehabilitation.

You should try telehealth physical therapy.  You will be amazed just how much you love it!

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