Pros & Cons Of Virtual Care (Telehealth): Physiotherapy Of The Future
Ready or not, Covid-19 has forced us to change a lot of things in our lives; where we work, how we shop, what we do for fun, and how we socialize. As a Dartmouth physiotherapist, I experienced the challenging, but necessary closing of our clinic doors and the sudden inability to provide care to clients. However, the need to provide ongoing care to new and existing clients didn’t just go away. I knew many clients would experience regression in symptoms and decreased quality of life without access to this care. Telehealth or “virtual care” offered a solution, this type of care has existed for decades to provide access to under-serviced areas, but slow to develop it in urban zones.
In full transparency, I was nervous to adapt to this form of care. Would I be able to achieve the same outcomes, would my clients feel it was a valuable use of their time and money, and most of all, could I get my crazy dog to settle for long enough to get through a 30-minute video conferencing session? After several months of navigating the ups and downs of virtual care, I can confidently and whole-heartedly promote this style of treatment. This article will seek to introduce the reader to virtual care, the bad, the good, and why it is here to stay.
What is Virtual Care (AKA Telehealth)?
Telehealth is an umbrella term for any type of healthcare delivered remotely, usually by telephone or video-conferencing. While reports of telehealth go back as far as 100 years or more, it seems modern telehealth in North America began in the 1960s and included projects by NASA to provide remote medical care to astronauts (1). At Choice Health Centre, virtual care means that you and your therapist each use a phone or computer with a camera to meet through a secure video-conferencing platform. Clinicians are able to assess their clients through subjective interviewing, and objective testing, much like in the clinic. They are then able to develop a treatment plan by using patient education, coaching, home exercises, and demonstrating self-treatment techniques for their clients. Virtual physiotherapy has been shown to be equally as effective as in-person care for treating a variety of musculoskeletal issues such as osteoarthritis, and low back pain (2, 3).
The cons of virtual care are fairly obvious. As a clinician, I can’t use my hands, which I have relied on to make decisions for treating, as well as for assessing and diagnosing until now. However, this may be less important than you think. Telehealth has been proven to be reliable in assessing pain, swelling, range of motion, strength, balance, and gait (4). However, it is less reliable at testing specific orthopedic structures and nerves (4). It can also be challanging to pick up on non-verbal cues like a painful wince. This makes communication and feedback between myself and my client especially important. I might need to ask you 10 times how something feels during a treatment because I won’t always detect it in your body language. The other downfalls to virtual care include technology failures and being distracted within your home. Some examples that I ran into were children needing help with online learning during an assessment, or cats chasing after myofascial release balls during a follow up.
For those who haven’t experienced virtual care, it may be surprising to learn that client-reported satisfaction of physiotherapy services delivered through telehealth is often higher than in-person care (5). After several months of treating virtually, I think I have discovered why. Firstly, it is more convenient. The biggest reported barrier to seeking virtual care is lack of time. Virtual care essentially eliminates the need to drive to appointments, take time off work, find childcare, etc. Secondly, you and your therapist have increased one-on-one time. Third, I can actually see your home and help to problem solve within your space. You can virtually bring me to your home office to let me see the desk set-up that gives you neck pain everyday. You can invite me to your home gym to show me that exercise that flares your shoulder up, and I can provide advice on technique in real-time. I have even been able to do a full running gait analysis for a client who had a treadmill at home.
In my opinion, the single greatest contributor to the success of virtual treatment is focus and dedication to movement as medicine. I don’t think you would be surprised if I told you that doing your physio exercises as frequently as recommended leads to improved client outcomes. Telehealth has shown consistent improvement in adherence to a home exercise program compared to in-person care (6). To make it even more user-friendly and engaging, the virtual platform that I personally use to conduct telehealth visits includes an app that helps you track your experience with each exercise and relays that information to me. It’s like Santa Clause who knows if you’re sleeping or if you’re awake. I can see if you’ve been doing your exercises, so be good for goodness sake! And if you have a question or a comment about an exercise while you are doing it, you can send me a message through the app. When has your clinician ever been so accessible to you?
To my telehealth clients, I want to thank you for bringing me into your home. Thank you for introducing me to your pets, and being patient as we both adjusted to a new way of treating. I know I can speak for all of the clinicians at Choice Health Centre when I say that we are so happy that we have reopened our doors to in-person care. To use another holiday reference, we’ve been told by many that coming back to the clinic was like Christmas morning. But let’s not forget that Covid-19 is far from over. Let’s still consider that there are higher risk individuals who should continue to limit their exposure to the public and that the threat of a second wave is real. Virtual care is here to stay, and I strongly believe it is not just “good enough for now” but it is the future of physiotherapy.
- Norris A.C. Essentials of Telemedicine and Telecare. John Wiley & Sons, Inc.; New York, NY, USA: 2001. [Google Scholar]
- Cottrell, M., Galea, O., O’Leary, S., Hill, A., Russell, T., 2016. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review & meta-analysis. Clin. Rehabil. 31 (5), 625–638. https://doi.org/10.1177/0269215516645148. Cottrell, M., Hill, A., O’Leary, S., Raymer, M., Russell, T., 2017. Service
- Dario, A.B., Moreti Cabral, A., Almeida, L., Ferreira, M.L., Refshauge, K., Simic, M., et al., 2017. Effectiveness of telehealth-based interventions in the management of non-specific low back pain: a systematic review with meta-analysis. Spine J. 17 (9), 1342–1351. https://doi.org/10.1016/j.spinee.2017.04.008.
- Mani, S., Sharma, S., Omar, B., Paungmali, A., Joseph, L., 2017. Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review. J. Telemed. Telecare 23 (3), 379–391. https://doi.org/10.1177/ 1357633X16642369.
- Cottrell, M.A., O’Leary, S.P., Swete-Kelly, P., Elwell, B., Hess, S., Litchfield, M.-A., et al., 2018b. Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Musculoskel. Sci. Pract. 38, 99–105. https://doi.org/ 10.1016/j.msksp.2018.09.014.
- Bennell, K., Marshall, C., Dobson, F., Kasza, J., Lonsdale, C., Hinman, R., 2019. Does a web-based exercise programming system improve home exercise adherence for people with musculoskeletal conditions?: a randomized controlled trial. Am. J. Phys. Med. Rehabil. 98 (10), 850–858. https://doi.org/10.1097/ PHM.0000000000001204.