Telerehab Physiotherapy: Comparable to In-Person Care… well almost.

Physiotherapy is a profession that is, at its core, a very physical health care modality. We are experts in movement and movement conditions that affect people’s’ day to day including quality of life and optimal physical functioning or performance. So while it makes sense that the majority of care is provided in person and hands on, advances in technology that connect us in real time provide us with the opportunity to provide alternate or supplemental care when circumstances do not permit in person visits. As such, we are introducing Telerehab at Bloom.

But how good can Physiotherapy care be if not done in person?

Recent research on Telerehabilitation (the Physio version of “Telemedicine” or providing health care through distance and video conferencing) shows that regardless of the patient population &/or disease studied (i.e. chronic lower back pain, post-operative total hips or knees, stroke, knee osteoarthritis, non-specific neck pain, pelvic floor dysfunction, etc.) most found telerehab comparable to clinic based therapy in measured patient outcomes such as pain, endurance, strength, balance, general health status, activity participation and more. Further, it was interesting to note that many studies found significantly better outcomes for the Telerehab groups (compared to in clinic care) for increased compliance with home exercises, ease to access appointments and overall satisfaction with care. It is important to note that I was unable to find a study that compared Telerehab care directly to a manual therapy only alternative.

Ok, so what tools or treatments can Physiotherapy use virtually?

While many Physiotherapist are “manual therapists”, meaning they provide direct manual input to a patient’s body to effect change, we also have MANY more tools and ways to assist people in their return to health and movement other than purely hands on. Further, almost all manual therapists provide patient education, self care strategies and tools, along with remedial or therapeutic exercises to compliment their manual therapy treatments. 

Here are some Physiotherapy tools that you may not even know are being used with you in person that do not require hands on evaluation or treatment and only enhances your care, while also maybe being the keystone to your success:

• Education on medical conditions, symptoms and how they affect movement, sensations, function, and prognosis

• Assessment and guidance on patterns of your daily life, how to optimize this to reduce strain on a patient, and how to optimize these patterns to assist with recovery and goal attainment. This can be very helpful to understand how your day to day influences and impacts your symptoms. You may have already even already completed a food/voiding/energy/activity/symptom journal or diary and reviewed it verbally with your Physio.

• Movement assessment and optimization can be done either hands on (in person) or, a lot of the time, through observation. I am sure you have been asked to show your Physiotherapist how you are doing something, i.e. sitting down, picking up your groceries or child, etc., from which they were able to instruct you on how to move more freely, stronger and more supported.

• Therapeutic Exercise instruction and progression. Each Physiotherapist has their own clinical skill set which includes exercise and movement based therapies – this is our foundation in training. These are then selectively chosen based on the patient’s condition, preferences for movement, and equipment available and could potentially include: basic & integrative core retraining, functional movement, strength or mobility training, breath work (from various origins including Yogic pranayama, Hypopressives or functional), general endurance and fitness conditioning, and more. Other movement modalities being used more nay Physiotherapists include principles of Yoga, Pilates, and more. 

In conclusion 

Of course, there will be times when a hands-on assessment and treatment would be the best and most appropriate option for care. However, with recent events such as the global pandemic with COVID-19, as well as busy schedules and extreme weather events that can increase last minute missed appointments, I believe it would only benefit us all if we utilize this already integrated technology to supplement care.

For more information on possible risks, benefits and limitations of telerehab, or other commonly asked questions including under which circumstances Telerehab virtual care may be preferable, please go here for more information.

¹ Mbada CE et al. (2019). Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Chronic Low-Back Pain. Int J Telerehabil.; 11(1): 41–58

² Azma, K. Et al. (2017): Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized control trial. J of Telemedicine and Telecare. 24(8):560-565 https://doi.org/10.1177/1357633X17723368

³ Mani S. Et a; (2019) Concurrent validity and reliability of telerehabilitation-based physiotherapy assessment of cervical spine in adults with non-specific neck pain https://doi.org/10.1177/1357633X19861802

⁴ Kinder J. (2019) Telerehabiliation for Treating Pelvic Floor Dysfunction: A Case series of 3 Patients’ Experiences

⁵ Cottrell, M. Et al. (2016) Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Volume: 31 issue: 5, page(s): 625-638 https://doi.org/10.1177/0269215516645148

⁶ Nelson M. Et al. (2020) Telerehabilitation is non-inferior to usual care following total hip replacement – a RCT non-inferiority trail.  https://doi.org/10.1016/j.physio.2019.06.006

⁷ Nelson M. Et al. (2020) Telerehabilitation is non-inferior to usual care following total hip replacement – a RCT non-inferiority trail.  https://doi.org/10.1016/j.physio.2019.06.006

Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.