We are living the future! Hoverboards, artificial intelligence, WiFi enabled washing machines and blue passports …so why not virtual physiotherapy? What for most people started out as the only way of accessing healthcare during the pandemic has now become a permanent means of receiving services, in some cases preferentially to attending in person. So are virtual appointments actually as good as in person sessions?
Transitioning from face-to-face (F2F) to virtual physiotherapy was something that many of us had never done, and having to do so almost overnight whilst also dealing with the other stresses of a global pandemic was a significant challenge, and many providers would echo these feelings [1]. Having spent my whole career assessing patients in person, telehealth required a lot of adjustment. But was it worth it?
Well it certainly seems so. Not only have therapists reported feeling that they could give their patients safe and effective care via telehealth[1], there is evidence that the care provided could be comparable with in person appointments for some conditions, and at the very least better than no treatment at all[2]. Whilst there may still be some critiques and trepidation around the use of telehealth[3], evidence does seem to show that telehealth has been an effective tool for both patients and therapists during the pandemic[3, 4]. So now that telehealth is no longer a necessity, is it still helpful?
There are obvious technological challenges to telehealth (‘I think you’ve muted yourself!’), and physiotherapists also describe challenges with things like diagnostic testing, hands on treatment, exercise prescription and just generally building a strong therapeutic relationship[7]. Evidence exists that telehealth is a viable and effective means of diagnosing shoulder, elbow and knee issues, and generally as an appropriate means of managing musculoskeletal disorders[8, 9, 10, 11]. Telehealth certainly seems to be a safe and effective means of diagnosing conditions and delivering treatment for individuals who are unable to get to appointments in person or who would just prefer remote physiotherapy. What is the consensus on the best way to utilise telehealth in the post-pandemic age then?
The Chartered Society of Physiotherapy (CSP) recommends that individuals are given the choice whether they wish to receive physiotherapy in person, remotely or as a combination of both[5]. This is supported by other research into the use of telehealth in the UK[6]. Furthermore, the use of hybrid services (a combination of virtual and F2F physiotherapy) are described as being safe, equitable, effective and responsive[5]. This allows for a much more individualised treatment approach for patients, whereby they have the benefits of the convenience and accessibility of remote physiotherapy, but also the ability to supplement this with hands-on, F2F physiotherapy where required.
In my clinical practice I have found that for many patients telehealth is a fantastic triage tool, as most serious or concerning conditions are ruled in or out via subjective questioning rather than objective testing[12], and as we have seen above a large number of diagnoses can be made with reasonable reliability without seeing the patient in person[8, 9, 10, 11]. Equally, for patients with long term conditions who need more generic support and intervention, telehealth can be very effective, in particular if a patients condition makes it difficult for them to travel for appointments. If a diagnosis is unclear, or a patients injury requires a very specific management plan (for example runners with tendinopathies that need load optimisation, or high-level athletes looking to return to sport), face-to-face physiotherapy is by far the best way to assess and treat these patients. Despite this, telehealth appointments are great ways to bridge gaps between appointments, particularly if a patient is away, has a flare up, or just needs some general advice.
So is telehealth physiotherapy virtually as good as F2F physiotherapy? The bottom line is it really depends on what your injury is, and what your needs are as an individual. I love seeing patients F2F, getting to know them, and being able to do a comprehensive assessment, and whilst at times I may need to see patients in person to give them a diagnosis, this isn’t always necessary for many people. Likewise, telehealth is a great option for you if time is precious or you struggle to get into a clinic for assessment, or need to supplement your F2F regime because of sudden changes in symptoms or personal circumstance. Telehealth is now a normal part of my day-to-day role as a physiotherapist, and I believe it really enhances the work we do and the scope that we have as physiotherapists to give patients the care that they really need in the best possible way for them.
To enquire about remote consultations with ABPT please use the following link: https://www.abptphysio.co.uk/about-3-2
If you have questions about what services you need or have any other symptoms please check the NHS guidance at the following links and follow the advice relevant to your symptoms: Health A to Z - NHS (www.nhs.uk) ; Find services near you - NHS (www.nhs.uk)
References
1 – Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic - PMC (nih.gov)
2 – Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview - PMC (nih.gov)
3 – Physical therapists and public perceptions of telerehabilitation: An online open survey on acceptability, preferences, and needs - PMC (nih.gov)
5 – National Evaluation of Remote Physiotherapy Services: the findings | The Chartered Society of Physiotherapy (csp.org.uk)
6 – Full article: Exploring the delivery of remote physiotherapy during the COVID-19 pandemic: UK wide service evaluation (tandfonline.com)
7 – ‘It's not hands-on therapy, so it's very limited’: Telehealth use and views among allied health clinicians during the coronavirus pandemic - PMC (nih.gov)
9 – Validity and reliability of the assessment and diagnosis of musculoskeletal elbow disorders using telerehabilitation - PubMed (nih.gov)
10 – Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation - PubMed (nih.gov)
11 – Telehealth for musculoskeletal physiotherapy - PMC (nih.gov)
12 – International Framework for Red Flags for Potential Serious Spinal Pathologies | Journal of Orthopaedic & Sports Physical Therapy (jospt.org)
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