During these difficult times a primary part of medicine has shifted. Medical care has shifted to telehealth for anything that does not have to be in person. What does that look like when it comes to physical therapy? There are 3 main differences: initial evaluations are incomplete, interventions are limited, and recovery depends on the patients actions. None of these things suggest telehealth is evil and in contrast is likely a very reasonable way to have follow up appointments for most patients in their course of care. In addition triage of patients is very useful when it comes to telehealth.
Physical therapy evaluation ideally includes a hands on component. A PT needs to utilize their hands to understand how you are moving, what hurts, and why you are limited by your issue. This includes understanding how your muscles, nerves, and joints all feel as well as how they move without your support. For people with some condition passive motion may feel better and hands on treatment of the body has a pain relieving effect. This means that there’s an incomplete understanding of what is occurring or what a person needs and may lead to a protracted course of care.
Limited number of interventions are clear. Not only is equipment lacking interventions such as manual therapy, dry needling, and assisted/resisted exercise can not be included. For patients with acute problems, those most likely to be seeking PT during a stay at home order, benefit most from these types of interventions. This shifts toward a management strategy and limits how quickly someone can improve.
Recovery really depends most on what the patient is able to do. This includes what types of things they have access to when it comes to strengthening or range of motion. It also requires to be in tune with their bodies; another thing those in pain struggle with. This sets up a need to create rules for recovery and what to look out for. Overall this does require increased focus on what patients say versus what the PT feels.
Success With Telehealth
Overall telehealth is a balance. In a perfect world the best interventions would be applied to each patient. When those interventions are limited it leads to a slowed recovery. The good news is patients are still able to recover albeit slower. During times when a patient is unable to attend PT such as a pandemic, difficulty leaving their home, lack of transportation, or even a tight work schedule telehealth is a valuable alternative. The physical therapists at Ascend Orthopaedics have extensive training on how to listen to a patient allowing us to tune in to what a patient needs, help them develop a strategy, and have a clear understanding of what they should and should not be doing. For these reasons Ascend Orthopaedics will continue to offer after stay at home orders are lifted and we begin to resume our normal daily routines.