The Unexpected Magic of Telehealth Physical Therapy
2020 has been a doozy of a year so far – and while I sit here writing this in late May we are seeing some sign of hope that this pandemic may be slowing. However, with social distancing as the new normal and many people with compromised immune systems continuing to need to shelter in place we have needed to become more flexible in the way we provide care to our community.
In PT school, we had a course one day on Telemedicine. We all felt that this was a little ridiculous – “when will I ever be providing healthcare through a screen? PT is a hands-on sport!”. Little did I know that just a few years later I would be seeing up to 80% of my caseload via telehealth, and even better I would be enjoying myself.
Is practicing telehealth physical therapy more challenging? Yes.
Is it at times harder to see things that would be obvious in person? Absolutely.
Does it also provide unexpected opportunity? Surprisingly yes.
What makes practicing telehealth at times frustrating?
- Limited equipment – I am only able to work with what the patient has at home
- Physical distance – I am not able to “feel” what is going on, nor can I reach in an “fix” it
- Viewing angles and video quality – I often have to find new ways to evaluate a system or movement that I would otherwise be able to see easily up close in the clinic
- Technical difficulties – everyone has different ability levels with technology and internet connectivity is not always consistent. While some days telehealth is as easy as chatting on FaceTime with family, other days connection issues can mean obstacles
Where is the magic?
- Limited equipment – Whatever we work on together as an exercise my patient is guaranteed to be able to continue perform at home because it uses what they have in their space
- Access to care – visits from home help reduce barriers related to travel, including traffic and physical disabilities
- Eliminated need for PPE – it’s a lot easier to breathe without a mask while exercising at home
- Limited exposure to both patients and providers – telehealth is often ideal for people with high risk conditions, including people with compromised immune systems who still need care that allows them to keep moving
- Fostering self-efficacy – Teaching patients manual techniques that they can perform on themselves and helping them strategize exercises solutions in their own space better helps them apply the concepts from physical therapy to the rest of their daily life
I have specifically found telehealth to be helpful with my older patients who often need help exercising and managing transfers in their home. One patient comes to mind who prior to this pandemic would come into our clinic and we would do some exercises and mimic transfers he was having difficulty with, but he never managed to do his exercises at home. Then came the pandemic and he lost access to his gym and was no longer safe to leave the house due to his compromised immune system. The unexpected upside was that we were able to tailor his program so that it worked for him in his home and I also was able to help him work through transfers that had been causing his falls. He has since made huge improvements in his balance, his strength, and his ability to navigate his home. For this patient I would argue that telehealth has made more progress for him than an in-clinic visit would have been able to.
Now does this mean I am jumping on the telehealth bandwagon for all of my patients? The short answer is no. People need different things from physical therapy and often an in-patient visit is needed in order to suss out symptoms with a more complex diagnosis, manage an acute condition, or provide some manual intervention for a patient who is really struggling with self-applied techniques.
However, if you have been waiting to get back to physical therapy for a cranky back, an ankle sprain or a sore neck that just won’t go away and you don’t want to come in to the clinic, give telehealth a try! You will be amazed at what can be done without your PT ever laying hands on you.