Healthcare technology companies have improved their ability to deliver physical therapy and other services remotely. Technology that can be delivered to a patient’s phone, tablet, or laptop has enabled case managers to refer patients to physical therapy services — even as the patients remain at home for safety or transportation reasons.

Success with virtual physical therapy depends on the screen skills of the physical therapist, as well as technology that provides optimal video. All that is missing is manual therapy by the therapist.

“Even in that case, you see that manual therapy is not the strongest tool we have in our toolbox, as therapists,” says Todd Norwood, DPT, OCS, SCS, director of clinical services at Physera in San Mateo, CA. Physera provides evidence-based, virtual care for musculoskeletal conditions.

“There is evidence that if you teach a patient how to self-mobilize, you can confer a greater benefit,” Norwood adds. “They’ll do much better than if we do something to them or for them in a clinic.”

Interest in virtual physical therapy among worker’s compensation case managers, payers, health systems, and others has peaked since the COVID-19 pandemic.

“We have seen a dramatic increase [in business], unfortunately, due to COVID,” says Dan Rubinstein, PhD, co-founder and chief executive officer of Physera.

A Physera survey of virtual physical therapy patients revealed that 98% showed improvement in their clinical area of concern, and 98% reported high satisfaction with the quality of care.1

Virtual Physical Therapy Can be Effective

“We had virtual physical therapy service in the pre-COVID world, but the post-COVID world has accelerated the interest and adoption of virtual physical therapy,” says Kevin Harried, CISA, CISM, chief risk and compliance officer with One Call in Jacksonville, FL. One Call is a specialty network management service for the workers’ compensation industry.

“We also can look at virtual assessments and solutions,” Harried says. “Say an employee had carpal tunnel or a back issue and now is working from home,” he explains. “We can get their work area set up correctly from an ergonomic standpoint, so it’s not just a couch and a dining room table.”

An in-home assessment can be performed remotely or in person. “Those are good opportunities to help workers after their injuries and to also help this new population of people, working from home, to prevent injury,” Harried says.

As many case managers have learned during the pandemic, working with patients and assessing their conditions via teleconferencing requires some different skills than working with them in person.

Physical therapists also need additional skills to succeed in virtual physical therapy, including a compelling screen presence.

“By and large, all the therapists have done very well,” Norwood says. “We have a robust screening process that we use to select therapists to hire for our network.”

The ideal physical therapist has good clinical experience, knowledge about the latest evidence, and is engaging over a screen. Physera staff conduct job interviews via videoconference to assess a candidate’s screen presence and skills.

“This is different from being engaging when you’re next to them in a clinic,” Norwood says. “We have rigorous training programs, following best practices and teaching therapists how to apply their skills and knowledge base and deliver therapy in an effective way, virtually.”

Physical therapy organizations can replicate the in-person physical therapy experience through a virtual device with some training, Harried says.

The virtual therapist cannot perform manual manipulation and assisted stretches, such as adjusting a patient’s shoulder or applying pressure as the patient stretches. But they can replicate some manual activities remotely. For instance, they can ask the patient to use a resistance band to show range of motion or strength, Harried explains.

“The things you can replicate: one, observe; two, have an exercise, strength test, or range of motion that you want the patient to do, and you observe that,” he says. “You can receive feedback from the individual, seeing their face and whether they’re in pain or discomfort.”

Virtual visits are interactive, and therapists can educate patients, instruct them on body mechanics and posture, and actively coach and monitor their conditions and progress on treatment plans, Harried says.

The pandemic has forced some physical therapy clinics to stop services temporarily. Others have moved into the telehealth arena. Physera shared virtual therapy tips, via a webinar, with physical therapy centers, Norwood says.

“We felt it was important to share some things we’ve learned and our best practices to help all the physical therapists that were in a tough spot to provide the best care of their patients,” he adds.

Physera’s interactive technology allows patients to watch and replicate therapeutic exercises via the screen, Rubinstein says.

“We are able to proactively monitor patients and drive adherence because we know when the patient is doing their exercises on our app,” Rubinstein says. “If they lapse, we reach out to them and encourage them to stay on track with the program.”

REFERENCE

  1. Demonstrating program efficacy: A claims-based cohort study. Physera Confidential, 2020. www.physera.com.