In a world where social distancing has become the norm, physical therapists—who usually offer hands-on treatments—are adapting to this new reality by turning to technology to stay connected with clients.
ProRehab, with locations in Indiana and Kentucky, is one of many medical clinics using telehealth to stay connected with clients recovering from injuries or dealing with long-term pain conditions.
With telehealth, a client communicates with a health practitioner remotely by phone or video, instead of going into the clinic.
Dr. Patrick Wempe
, a physical therapist and CEO of ProRehab says the concept of telehealth in physical therapy is not new.
“We’ve always had some type of engagement with our clients through the phone,” he says. For example, on Friday football nights he would often get calls from coaches or parents asking whether a player’s injury was serious enough to need a trip to the emergency department.
What’s different now is physical therapists can bill insurance companies more easily for these kinds of virtual visits. So telehealth has become a greater part of how clinics work with clients during the pandemic.
“Now we are using video to engage with our clients. In some cases they have never seen a physical therapist before,” says Wempe. “It’s also allowed us to initiate some type of planned care for a person who is essentially homebound.”
Many people are staying at home during the pandemic because it helps slow the spread of the new coronavirus. But others are staying home because they have a higher risk
of serious illness with COVID-19. This includes older adults and people with other medical conditions.
For people who don’t want to or can’t come into the clinic, telehealth provides a way for them to connect to a physical therapist or other provider. This includes people with a new injury or those with an ongoing medical condition such as chronic pain.
Dr. Sean Li
, an interventional pain physician and regional medical director of Premier Pain Centers, an affiliate of National Spine & Pain Centers, says telehealth can work well for both current and new clients.
Wempe, though, finds that it’s easier to work with existing clients, because he already knows about their injury or condition. He also adds that Medicare enrollees have to be established clients before they can interact with a therapist through telehealth.
It may seem odd that a physical therapist would treat clients virtually, when normally they would be using many manual therapy techniques. But Wempe says “many things can still be done through the use of a smartphone.”
For existing clients, a virtual visit helps them maintain a sense of connection with their physical therapist, says Wempe. It also provides them with some continuation of their therapy program.
So even if they aren’t doing everything they would in the clinic, they can still do enough to keep making progress. The therapist can also check in with clients to make sure they aren’t running into trouble with their injury or condition.
As for the physical exam, Wempe says it is “certainly less than what we would do if someone was in front of us.” But there are still many things that can happen.
For example, a physical therapist can use a video call to check on a person’s range of motion or swelling to see if it has improved or worsened.
For older clients, the therapist can see how well they are moving around or navigating their home environment. A video call might even be the first time the therapist has seen the client in their home, which can provide useful information about how they are dealing with their injury or condition.
Wempe says doing telehealth with older adults doesn’t always work well, because some may not have a computer or smartphone, or they may not be comfortable using the apps needed for video calls.
In spite of the limitations of telehealth, much of what physical therapists do goes beyond hands-on therapies. Education is an important part of this, especially for clients with acute or chronic pain.
“In some folks who have been dealing with pain for a long time, the pain is a real clinical entity that we have to deal with,” says Wempe. “And there is a huge education component to that.”
He says therapists can teach clients techniques like mindfulness or deep breathing that can “help initiate pain reduction, so clients will be more open to movement.”
Li also does a lot of educating of people online. His clinic’s telehealth software program provides clients with a list of suggested exercises based on their medical history. “From there, I usually teach them during our chat,” he says.
Some people are receptive to having to do more of their therapy on their own. Others need a little push.
“Some clients want to get better and will do the exercises. Some just need the encouragement to move,” says Li. “I spent 10 minutes trying to erase the word ‘can’t’ from a client’s vocabulary this afternoon.”
Still, he says “patients usually don’t mind when I’m trying, sometimes even begging them, to take ownership of their health.”
Wempe says encouraging and reassuring clients is an important part of physical therapy, what he calls the “soft skills” of the practice.
Even with telehealth, a physical therapist can provide clients with “reassurance that they're not running into trouble and reassurance that they’re going to be okay,” says Wempe.
Overall, he thinks telehealth has been successful during the pandemic. He also thinks the current use of it is “just scratching the surface” of how physical therapists might use virtual visits going forward.
Whatever the future looks like, telehealth is really just another way to help clients. But advances in technology have made it much easier for clients and physical therapists to connect virtually.
“The video quality has allowed patients to truly continue their care — or initiate their care — under the guidance of a physical or occupational therapist,” says Wempe. “Hopefully, [the virtual visits] will lead them to hands-on care down the road when they feel safer coming into the clinic.”
Updated: May 12, 2020