Telehealth physical therapy:
COVID-19 has disrupted many lives and thrust us into adapting and offering different levels of care for client's who are unable to leave home or "fearful" of being in an outpatient or clinic setting with others- telehealth and telemedicine has been around for years, however, ever-changing State policies & guidelines are allowing providers to adopt telehealth services as a "norm" which is the push we need to advance our medical profession and offer alternative options for clients in need.
About Telehealth PT //
What is telehealth physical therapy (PT)?
Simply put, “telehealth physical therapy” (or “virtual physical therapy”) refers to physical therapy services that are provided over a technology platform, rather than by in-person means.
Other phrases referring to telehealth physical therapy might include:
telemedicine physical therapy | telePT | teletherapy | telerehab | telemedicine physical therapy | online physical therapy | virtual physical therapy | remote physical therapy
How is telehealth physical therapy delivered?
There are four ways to deliver telehealth PT services:
1. Live video. This is also referred to as “synchronous” format, and uses live interaction between two parties over video. It’s also sometimes called “real-time.” This type of delivery is ideal for evaluations and treatments.
2. Store-and-forward. This is sometimes called “asynchronous” format. This involves the transfer of health history and/or medical records over secure electronic means. This type of delivery is best for sending x-rays, progress notes, etc. This delivery is scalable, and can also be used for subscription model delivery of services.
3. Remote patient monitoring (RPM): This involves the remote monitoring of patients’ health and medical data over secure electronic means. This type of delivery is ideal for monitoring patients’ blood pressure and/or blood glucose measurements, steps per day, etc.
4. Mobile health (mHealth): This involves healthcare services, education, and public health notifications being delivered over cellphones, tablets, and other electronic devices. This type of delivery is ideal for alerting patients to updates to their HEP, as well as the closure of roads near a clinic, a possible disease outbreak, etc. Examples of this are WebPT’s HEP software and MedBridge’s HEP program.
Why should PTs use virtual physical therapy?
Right now, we’re facing unprecedented times. With “social distancing” becoming the norm, each state is facing the difficult decision of whether or not physical therapy is considered “essential.” And, as we all know, “essential” is a loaded term. Nobody would argue that PTs are essential to triaging musculoskeletal injuries and ensuring safe discharge planning—which keeps our hospitals streamlined and best prepared to face the onslaught of COVID-19 patients.
However, most therapists can probably agree that a mild ankle sprain won’t exactly require immediate in-person attention from an outpatient orthopedic physical therapist.
Then, there’s that gray area of vulnerable post-CVA patients whose homes need evaluating. After all, the last thing they need right now is a fall, sending them right back into the COVID-19 hot zone.
Frankly, we’re at a crossroads, and it’s the ideal time—albeit under terrible circumstances—to get our act together as a profession, and to serve patients to the best of our ability with the primary intent of, first and foremost, doing no harm.
Telehealth physical therapy as tool for education.
Patient education is a primary component of physical therapy telehealth.
While manual therapy is still an important component to our treatments, it’s certainly not the be-all-end-all. In fact, many therapists can attest to the fact that too much manual therapy makes patients dependent upon the therapist, when what they really need is to be up and moving. As patient education and pain science are increasingly influencing treatment choices—and ineffective treatment modalities are falling out of favor—PTs are finding that their role as movement experts relies less and less on patients being physically in the clinic for treatments.
The primary duty of PTs, aside from doing "no harm to patients," is to educate them. Teletherapy is the perfect way to educate patients who otherwise couldn’t access care.
Whether they’re under "shelter-in-place" orders or simply unable to make it to appointments under normal circumstances, there are tons of options to use telehealth PT as an educational tool.
Teletherapy as a method of convenience.
People are attached to technology more than ever before.
We live in an on-demand society. People want what they want, when they want it. Even before COVID-19 began dominating our daily lives, people were changing how they approached life. Patients are trending toward wanting immediate care, and they don’t want to wait weeks for an appointment, especially if they only need exercise prescription and general education/guidance.
Many other medical providers, including radiologists, psychiatrists, and dermatologists, have recognized this fact, and have been providing telemedicine for years. And, since the novel coronavirus has truly begun dominating our lives, even more medical providers have stepped into the role of telemedicine providers.
Telehealth PT as a solution for access.
Frankly, these days, convenience is a fairly moot point.
At this point, we really need to think about how we can serve our patients best during these challenging times.
And that means providing them the best possible access to care they might not otherwise get.
Here are a few common use cases:
Prevention of readmission through home safety evals and mobility screens
Post-discharge checkups and safety screens
Advanced intake of subjective history
Wellness and preventative services to avoid hospitalizations
Consulting with other practitioners
Post-surgical monitoring and rehabilitation
Q and A to prevent hospital readmissions and future injuries
What does the evidence say about telehealth PT?
What’s in favor vs. what isn’t doesn’t always matter if the evidence argues otherwise. It turns out that our magical healing hands may only be a small part of the puzzle.
A UC Irvine School of Medicine study recently revealed that telehealth PT was as effective as in-clinic therapy for improving upper extremity motor control post-CVA. (source)
According to Mani et al., there is a high level of agreement between an in-clinic PT diagnosis and a diagnosis obtained via telehealth using a remote diagnosis and a functional movement screen (FMS) (source)
A review of 75 systematic reviews and 71 Cochrane reviews revealed that the most effective interventions for low back pain (LBP) are patient self management, psychosocial interventions, and therapeutic exercise (source)
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