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Tele-rehabilitation – Another Tool in Your Toolkit

Jan 23, 2019

By: College Practice Advisor

What is tele-rehabilitation?

With the assistance of technology, as a practice advisor I have the good fortune of being able to work remotely from my home office. As technology becomes more advanced and a growing part of our everyday lives, tele-rehabilitation is a mode of practice that more physiotherapists are considering.

Tele-rehabilitation is the provision of physiotherapy services from a distance and involves communication with a patient who is remotely located from the primary physiotherapist providing service.

It incorporates the use of technology such as video conferencing, email, apps, web-based communication or wearable technology.

When is an appropriate time to choose tele-rehabilitation over an in-person interaction?

Tele-rehabilitation may be used to facilitate physiotherapy care by delivering service not otherwise available without compromising care or regulatory accountability, such as for patients located in remote areas where physiotherapy services are not readily available. Imagine the possibilities for improved patient care by a physiotherapist who works in Northern Ontario, limited by travelling great distances to reach patients, who could then treat eight patients in a day rather than two or three. 

There are a few things you should consider before incorporating tele-rehabilitation into your practice. First and foremost, as a physiotherapist you have an accountability to make sure your decisions are always in the patient’s best interest and aligned with your patient’s expectations of care.

What are the special considerations for tele-rehabilitation?

It goes without saying that physiotherapists must comply with all regulatory requirements and deliver the same safe and effective care… but what else should you consider?

You must decide if tele-rehabilitation is the most appropriate and available way to deliver care. Is an in-person, hands on examination needed to complete the assessment and determine a clinical analysis, treatment goals and plan? Will the patient be safe under the care of the physiotherapist within the context of their home or work environment? Are there physical, cognitive or sensory deficits that may make the delivery of physiotherapy care unsafe or ineffective? Can someone be available to assist the patient if needed at their location? How will you protect the safety of your patient’s personal health information?  Are you competent in the use of the technology, its capabilities and its limitations? If you are providing physiotherapy care in another province you must understand and comply with their privacy rules and be registered to practice in that jurisdiction.

Additionally, you should have a plan in place to deal with potential adverse events such as patient medical emergencies, failure of the communication technology or environmental hazards. 

And, don’t forget about consent!  You must have a discussion with the patient and provide all the information they would need to make an informed decision about their care. Be sure to include things like: the difference between in-person and tele-rehabilitation services including options to receive in-person care, the risks to the privacy of their health information and any safeguards in place to reduce these risks. 

For more information, please give the Practice Advice team a call at 1-800-583-5885 (ext. 241) or email advice@collegept.org. We are available to chat with you about the ins and outs of tele-rehabilitation and answer any questions you may have. 

The Canadian Alliance of Physiotherapy Regulators also has several great resources about tele-rehabilitation (including across provincial borders) in practice on their website.

Tele-rehabilitation in Physiotherapy

Leave a comment
  1. Amy | Jun 10, 2020
    While I understand the desire to return to practice, the argument made that positions telehealth as equivalent enough to face-2-face interventions requires a huge leap, one that has not been evidenced sufficiently.  The evidence base does not support telehealth used by physiotherapists in part because there was no gold standard in care prior to the pandemic to compare it to.  Manual therapies, acupuncture (dry needling) and other go-to interventions have never been shown to provide more than transient, modest effectiveness that is arguably inseparable from placebo.  Substituting telehealth limits the nuanced interactions between therapist and client only possible when engaging in person.  Claiming to be able to assess function using telehealth will inevitably force the discussion to include, why does it take a physiotherapist to do what is already available by others for far less?   Check out YouTube And you will see everyone and their uncle offering telehealth advice for msk disorders!!  This is a risky position to take for the PT profession looking to the future when it struggles with an identity uniquely its own.  Need to define what the professional identity is first in order to serve to public with high value care, then look for the tools to deliver value, not vice versa. 
  2. Richard MacLean | Jun 05, 2020

    To those reluctant and dismissive physios in the group above I will speak from my own limited experience to refute their skepticism at least from an effectiveness point of view.  I started doing telerehab with the goal that I might be able to help some people at least stay stable.  While I didn't hit it out of the park with all, I had 4 people with brand new injuries that I assessed virtually and was able to achieve full recovery and discharge.  It took some ingenuity to anaylze their issues and yes there was more room for error in their diagnosis but to my surprise they responded very well.

    I did have several patients that had minimal response and they dropped off quickly and said contact them when they can come into the clinic. But in addition to the handful of full recoveries, I also had many more that made significant partial recoveries.

    I concede I am looking forward to going back to my traditional ART, manual therapy, acupuncture, laser and in clinic exercise approach, but found pleasure in thinking outside of the box and figure out how to help the majority of people I treated virtually. 

    While I don't know if this is the future of physio, I think it is an important aspect for the foreseeable future and we need to figure out how to do it well (and safely).  There are limitations right now like quality of cameras and poor quality video when the bandwidth is low or your lighting sucks (I will not be stealing any lighting or camera persons job any time soon). But there are advantages (No Covid) such as greater buy in from patients to do their exercises, increased education on use of self soft tissue mobilization, observing and teaching exercises with what the patient has at home and less stress for the patient to attend the clinic.  Many of my patients that I assumed would want to rush back to seeing me in the clinic have stated they are happy to continue with the current course as they are seeing progress and want to avoid the potential risks of coming in the clinic.

    I hope others have seen their patients benefit from virtual rehab and hope it encourages some of you to take on the challenge of helping people that can't or won't come into the clinic due to the pandemic.  I challenge you to think of new ways to test strength and function.  Yes it's different, challenging, annoying at times, but it can benefit patients and it is here to stay at least for now.

  3. Patricia | May 11, 2020
    I would encourage the PT community to consider reading the latest blog posted by Dave Nicholls on Critical Physiotherapy Network.  The title is called, "Is COVID showing us the future for physiotherapy?"  He offers some excellent cautionary words regarding blindly embracing telehealth as it relates to what is considered uniquely physio.
  4. Daniel Lustgarten | May 07, 2020

    Ms. Anders spoke about the Phzio virtual physiotherapy platform.  If anyone could give more information about this (how user friendly it is, what technology must one have to set it up, etc) it would be appreciated.  I agree with many of the concerns stated above, but for the sake of keeping patient visits within the clinic to a minimum, this might well be a help.  Please enlighten those of us who have not done this.  Thanks! 

  5. Dr | Apr 17, 2020

    In a situation like Covid-19 which is almost a World War3 between human vs virus

    I was expecting to see a relief from too many restricting regulations.

    Our purpose is to try to help individuals to avoid traffic into health facilities and hospitals.

    If the college of physiotherapist exists for the purpose of protecting patients please try your best to abide to your Slogan.

  6. Susan | Apr 02, 2020

    Physical tests play an important role in making proper diagnosis. How is it done based on just just ROM, Functional eval etc.? New assessments are technically not fully reliable based on tele-rehab. The best use it can provide is supervised exercises. Clinics are just trying to use this platform to keep businesses running during pandemic. 

    Many of physios are not even competent enough to provide tele-rehab. We were trained for in person assessments and manual therapy. It can put PT licence at risk for incompetence/ negligence / privacy issues etc.

  7. Tom | Apr 02, 2020

    Despite the COVID-19 pandemic, physiotherapists eager to embrace telerehab might be wise to consider that for such a traditional profession with deep roots in physical touch, the challenges presented require a re-thinking of the entire profession.  Sure, the potential to help is there, but the lack of evidence to support quality assurance, maintaining standards of care, etc. Is extremely troubling.  The profession has been struggling with its professional identity for decades.  Telerehab won't save the profession from the inevitable questions that come about if physios use the pandemic as license to try something, because after all, it's a "pandemic".  Physios better lawyer-up, regulators get ready for a slew of complaints, and the profession better get ready for competition between PTs across provincial borders.

    Once again, physios chasing the next shiny object. 

  8. Jennifer O'Neil | Mar 26, 2020

    Hi Everyone, 

    A few weeks into our current reality of COVID-19, wondering how the implementation of telerehab is going in your practice? Have we all took the appropriate time to mitigate risks before trying to implement this remote service? 

    In this time, telerehab could be use to support existing home-exercise programs, provide education and assess certain aspects of a client's function. Let's keep self-reflecting on the harm and benefits of this tool and be well prepared before offering such services to our clients. 

  9. Ian Budge | Mar 21, 2020

    Are there any indicators as to whether allied health services (such as physiotherapy) can be covered as 'telehealth'. I understand that 'telehealth' is possible currently and that we can offer this to our patients however can you give us any indication as to whether physiotherapy provided will be covered under a patients extended health care plan? Companies that cover physiotherapy services regularly should be contacted and asked if their regular coverage can be applied to 'telehealth' providing its compliant with college standards- especially in the case of COVID-19 as this is a extenuating circumstance.

     

    Thank you!

  10. Christine Bridle | Mar 17, 2020

    In light of the Coronavirus outbreak this is a great option to follow up with patients that need monitoring of their ROM and progression of their exercises.

    I can see that it will be difficult to do new assessments.  We must declare that we are in a state of emergency and that clinics are closing due to an outbreak, and patients or staff are quarantined.   Then with informed patient consent we can offer advise, partial assessment ( subjective, ROM, functional movements, no manual testing).  

    This is an option to at least get people doing exercises and provide them with education on posture, ergonomics etc, that can help them while they are on quarantine at home in this health care crisis.

    Exercise is part of what we do and it can be done virtually if you have the tools in place to provide privacy for the patient and you get informed consent.  Our EMR is already in place to email a link to a secure sight for patients to access their exercises on line. 

    It would be irresponsible to just drop the post ops that are on the road to recovery. 

    The cases will surely die off as elective surgery is cancelled in Ontario at this time. 

    Lets get our patients moving safely within their own homes and be flexible in how we provide treatment in this health care crisis.

    Just my opinion

     

     

  11. Dave | May 14, 2019

    I await the first legal challenge faced by the physiotherapist who uses this and has their practice challenged in a court of law.  

    To compare physio with meds in this respect is missing the point.  For a family doctor to reissue a prescription via telemedicine is one thing.  Assessing a patient using the traditional approach of physiotherapists either requires face-to-face contact, or such an assessment never did, so where does that leave the physio? 

    This topic has never been fleshed out sufficiently and most physios I know won't take the chance of something going wrong when using this, and how easily they could find themselves being sued for negligence.

  12. Heather Anders | Mar 18, 2019
    Thank you CPO for making a statement about this new way of practicing that can transform access, remove barriers, and hopefully provide more options for PTs in their careers.  The right platform is essential to ensure we are meeting all of the proper requirements, and in my opinion, it is a mode for PTs who are already confident and competent with in person care.  I have used the Phzio platform and love it!
  13. Rohit | Jan 24, 2019

    Its a great idea. Many physicians use this method.

    Physiotherapist can also help more patients by this method. For  example if patient is bed ridden or can't drive or weather issues, tgat way patient can video call, get email or call to know what he can do to help himself.

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