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Telehealth in Physical Therapy: What Can and Can’t Be Managed Online

Telehealth in physical therapy is probably here to stay

By Jennifer Larson, contributor

Telehealth was already gaining in popularity before the pandemic began. But when hospitals, clinics, and medical offices needed to limit their in-patient visits to reduce exposure to the novel coronavirus, telehealth really began to take off. That includes telehealth in physical therapy.

For example, in March, Cincinnati Children’s Medical Center only needed about two weeks to launch a robust physical therapy telehealth program to give their young patients the chance to continue receiving the care that they needed. 

“There was not much downtime at all,” notes Nancy Durban, PT, MS, DPT, a physical therapist at the medical center and a spokesperson for the American Physical Therapy Association (APTA).

And the patients and their families responded with gratitude.

“With anything that’s new, there was a little bit of hesitation,” says Durban. “But actually, the majority of patients’ families were like, ‘This is great. We still need care, but we don’t want to risk exposure. So, thank you so much.’” 

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Benefits of virtual physical therapy 

Telehealth offers numerous benefits to patients, says Wendy Cao Noakes, PT, DPT, SCS CSCS, CF-L1, a physical therapist who specializes in sports physical therapy in California and co-founder of GetFitt.ed. 

For example, patients can receive care from their physical therapists from the comfort and convenience of their own homes. They don’t have to travel and incur travel-related expenses, which can be a big advantage for people who live a long way from their physical therapist’s office.

“There is no need to take time off work to drive, find parking and wait in the waiting room,” Noakes adds. 

Plus, during this pandemic, that opportunity reduces a patient’s chances of exposure to the coronavirus (or other infectious diseases), which can reduce their anxieties. 

“As a result, there has been a significantly lower ‘no show’ (rate) or last-minute cancellations,” Noakes says. 

Of course, some conditions lend themselves to telehealth management better than others. 

“As a pelvic floor therapist, I find that urinary incontinence and other bladder symptoms such as urgency, frequency and waking at night to void are perfect for managing via telehealth, as there is a large component of education and behavioral modification involved in their therapy,” says Angela Fishman, PT, owner of My Pelvic Therapy, PLLC. 

Limitations of telehealth in physical therapy

While telehealth can be a good option for many patients, it may not be appropriate for every patient or every situation. For example, when Durban’s program switched to telehealth when the pandemic began ramping up, some patients continued to receive in-person physical therapy.

“We couldn’t shut down 100 percent,” she explains. “We still had to see the children who were critical. You had to weigh their risks of being exposed (to the coronavirus) to the risk of not having treatment. That would be the post-surgical patients.” 

There are cases in which specialized equipment is necessary, too, which can be a limitation. 

Todd Norwood, PT, DPT, OCS, SCS, director of clinical services at Physera, began incorporating telehealth into his practice in 2016 and now uses it almost exclusively. But he recognizes some limitations.

“There are certain diagnostic tests we cannot perform remotely, so if I need to know if the patient’s reflexes are normal to confirm my diagnosis, I would need to see them in person,” he says. 

Other considerations

If your physical therapy practice is planning to implement a telehealth component in the future, here are a few things to consider, according to the APTA:

  • Check your state licensure laws. Find out how your state practice act addresses telehealth, as well as nearby states. You may have patients who live across a state line, so you want to be sure you are legally allowed to provide care for them.
  • Verify what kinds of services you can provide via telehealth. You could check the APTA’s list of state actions.
  • Make sure you’re using secure technology. HIPAA still applies, so you want to make sure your platform is HIPAA-compliant.
  • Develop policies and procedures to guide your practice in important issues such as informed consent.

It may help to spend some time learning more about telehealth in the practice of physical therapy, too.

“I don’t think telehealth is something you just jump into,” says Norwood. “As a first step, I would suggest taking a continuing education course on the topic, reading some of the research that supports it and reviewing some of the resources APTA has made available.” 

Here to stay

Some physical therapists, including Durban, have moved back toward offering more in-person visits, while keeping an eye on coronavirus numbers. But even after the pandemic is over, telehealth appears to be an option that is here to stay.

Like many others, Bay State Physical Therapy began offering telehealth appointments to its patients when the pandemic began. As it turns out, the patients liked it, says Steven Windwer, DC, PT, the organization’s president and CEO.

In fact, a recent survey conducted by Bay State Physical Therapy with Northeastern University’s Department of Physical Therapy, Movement and Rehabilitation Services, found that 95 percent of the patients polled reported being very satisfied with their telehealth experience. Plus, more patients kept their appointments. 

“In our first week, our company did 1,600 visits and we have performed over 25,000 telehealth visits to date,” he says. “We did it to maintain access for our patients, not knowing if we would be reimbursed because it was the right thing to do.”

He noted, “We have clearly demonstrated that telehealth has a very valuable place for our patients in the future.”

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