Benefits of Telerehabilitation
Physical therapy (PT) is commonly regarded as a “hands on” profession. However, over a decade ago, in order to meet with consumers’ demands for faster and more convenient care, physical therapists (PTs) began incorporating innovative technology with traditional in-person care delivery. The concept became known as telehealth and telerehabilitation (telerehab).
Prior to the recent outbreak of Coronavirus (COVID-19), several states acknowledged that telerehab was an effective adjunct to traditional in-clinic methods. During the COVID-19 pandemic, many states are deregulating the rules surrounding telerehab to allow patients to continue with a current therapy treatment plan, while adhering to shelter-in-place and social distancing orders.
In fact, as of April 16, 2020, 45 states issued executive orders permitting PTs to provide telehealth services, and this number is expected to grow. The Centers for Disease Control and Prevention (CDC) recently offered guidance to ambulatory care settings, such as outpatient therapy clinics, urging them to consider the use of telehealth services as a method of care delivery to mitigate the risk of exposure to COVID-19, as well as potentially reduce the number of patients who might otherwise seek care in physician offices, which can propagate the spread of the virus.
Benefits of Telerehab
- Increased patient reach/access (especially those living in rural areas or who have limited access to care)
- Decreased missed visit rates
- Cost savings (generally through travel-related expenses)
- Can be performed in a variety of locations (home, work, etc.)
- Patient satisfaction is equivocal to traditional care
Limitations of Telerehab
- Patient technology challenges
- Internet connectivity challenges
- Hands-on approach needed (i.e. manual therapy, certain neuro assessments such as deep tendon reflexes)
- Considerations for patients with balance deficits
Despite some limitations, telerehab offers a safe and effective alternative to traditional in-person care, especially during times of emergency, such as seen with COVID-19, when precautions must be taken to prevent transmission of disease. In fact, the American Physical Therapy Association’s (APTA) House of Delegates recognizes telerehab as “a well-defined and established method of health services delivery that enhances patient and client interactions.” The Federation of State Boards of Physical Therapy expressly states that the standards of care provided during in-person encounters must also be followed for telerehab visits. Additionally, PT and occupational therapy (OT) state boards across the nation have recently provided recommendations to ensure appropriate administrative, clinical, technological, and ethical regulations for the implementation of telerehab programs in light of the pandemic. For example, the therapist must obtain informed consent and maintain confidentiality of the patient and the patient’s record. Each therapist must treat within the scope of therapy practice and pertaining to the needs of the patient, and HIPAA must be followed to the extent feasible. The provider must also ensure that procedures are in place to address any medical or clinical emergency that may occur during the course of remote treatment.
Bardavon’s Best Practice Recommendations
Bardavon realizes that these unprecedented times have required an adaptation in the delivery of clinical care. We are taking measures to ensure that the quality of care to our nation’s injured workers is not compromised. Bardavon has developed treatment pathway recommendations that are shared with our National Network of Providers to ensure patients are set on the proper clinical pathway, whether in-clinic, telerehab, or blended.
In the event that an injured worker is not able to complete a therapy course of care in-clinic, telerehab is considered an acceptable alternative solution if the following considerations are made:
- Every attempt should be made to keep the patient onsite, provided it does not pose a health or safety risk to the patient, the clinician, or others accessing care at the location.
- When possible, clinicians will utilize a blended model of telerehab care delivery, in which therapy services are provided in-clinic for the first and last visit with interim visits completed remotely via telerehab communication technologies.
- If it is deemed most appropriate to utilize only telerehab communication technologies for care delivery, the clinician must abide by state practice acts regarding telerehab as well as guidance from the American Telemedicine Associations’ Principles for Delivering Telerehabilitation Services, which outlines administrative, clinical, technological, and ethical principles.
- In all instances—in-clinic or telerehab—the level of care delivered must be comparable.
Telerehab and online technology will continue to evolve. Practitioners must adapt clinical skills to meet these advancements. With current social distancing and shelter-in-place orders due to the spread of COVID-19, it is the responsibility of healthcare professionals to adapt to these changes in order to continue to provide care to their patients, while mitigating risks to overall health and well-being.
State Emergency Orders Permitting PT’s to Provide Telehealth Services. American Physical Therapy Association website. https://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Technology/Telehealth/Coding_and_Billing/TelehealthCOVID19StateEmergencyOrders.pdf. Updated April 16, 2020. Accessed April 20, 2020.
Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html#. Accessed April 09, 2020.
Covert L, Slevin, J, Hatterman, J. The Effect of Telerehabilitation on Missed Appointment Rates. L Covert et al. Int J Telerehabil. 2018; 10(2): 65-72. https://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6258/6792
Lee A, Billings M. Telehealth Implementation in a Skilled Nursing Facility: Case Report for Physical Therapist Practice in Washington. Phys Ther. 2016; 96(2): 252-259. https://doi.org/10.2522/ptj.20150079.
Bini SA, Mahajan J. Clinical Outcomes of Remote Asyhchronous Telerehabilitation are Equivalent to Traditional Therapy Following Total Knee Arthroplasty: A Randomized Control Study. J Telemed Telecare. 2017; 23(2): 239-247. doi: 10.1177/1357633X16634518.
Turner, A. Case Studies in Physical Therapy: Transitioning A “Hands-On” Approach into A Virtual Platform. Int J Telerehabil. 2018; 10(1): 37-50. https://dx.doi.org/10.5195%2Fijt.2018.6253.
Telehealth in Physical Therapy in Light of COVID-19. PT in Motion News. http://www.apta.org/PTinMotion/News/2020/3/16/TelehealthCOVID19/. Published March 16, 2020. Accessed April 5, 2020.
Telehealth in Physical Therapy. Policy Recommendations for Appropriate Regulation. Federation of State Boards of Physical Therapy. https://www.fsbpt.org/Free-Resources/Regulatory-Resources/Telehealth-in-Physical-Therapy. Accessed April 09, 2020.
Richmond T, Peterson C ,Cason J, et al. American Telemedicine Association’s Principles for Delivering Telerehabilitation Services. Int J Telerehabil. 2017; 9 (2): 63-68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716618/pdf/ijt-09-63.pdf.