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Telehealth, physical therapy and the pandemic: Lessons for all

This article was originally published February 14, 2022 on HealthcareITNews by Bill Siwicki.

For vulnerable patient populations – and for those who just prefer the convenience of care at home – telemedicine has been a success. But it still has its limitations.

For example, the precise movements and exercises involved in physical therapy rehab are hard for a patient to accomplish remotely. A provider on a video call may seem about as valuable as a YouTube video.

But there are new technologies and strategies that link patients, safely, to at-home physical therapy care that balances telemedicine with in-person visits. Many experts say this is the future of telemedicine: a hybrid of in-person and virtual care.

A rehab-at-home strategy lets health systems and orthopedic groups bring outpatient PT treatment to patients in lieu of forcing them to travel twice a week, in some cases more than five miles away, to obtain postoperative care.

It also helps healthcare organizations improve the profitability of their rehabilitation services by expanding access to care, standardizing care to avoid surgical complications, improving adherence, enhancing patient experience, lowering costs and reducing referral leakage.

Healthcare IT News sat down with Dr. Juan Manuel Aragon, director of business development at Kirkland, Washington-based EvergreenHealth and clinical instructor in the department of health services at the University of Washington, to discuss telehealth, physical therapy and lessons learned from the COVID-19 pandemic.

Q. How has the COVID-19 pandemic reshaped care delivery for physical therapy?

A. Patient demand for alternative means of care has skyrocketed during the pandemic. At the height of the pandemic there was a reluctance to access many health services in person, unless it was for a serious illness.

As the pandemic progressed, it became clear we needed to evolve to meet the changing needs of our patients and community. With the help of technology, we've made strides in advancing our ability to serve physical therapy patients in different ways.

First, we've discovered we are able to help patients and deliver high-quality care without having to be physically in the healthcare setting – a hospital campus or satellite facility. Providers also are making better use of educational and accountability tools to help patients perform their exercises.

We now are leveraging these platforms to make better use of asynchronous technologies such as YouTube or hosted videos to instruct patients on exercises and better utilization of wearable technologies to track movement, performance, falls, gait, etc.

Second, we have clarified the role of remote technologies in the provision of care. We're not talking about replacing care or moving it to a completely automated platform, but using technology to bridge the needs of consumers and therapists.

We've seen the need for patients to accomplish more of their rehabilitation milestones from home now that they are working remotely, spending far more time at home and – in many cases – wanting to maintain social distancing.

To this end, we're using a technology-driven service to connect patients with in-home physical therapy services. This has proven more convenient for both the patients and therapists while allowing for that all-important in-person interaction during therapy.

For health systems, it has introduced the ability to build hybrid approaches to care. In physical therapy, multiple appointments are often required. We have been able to integrate technology on a personalized basis to achieve the outcomes that the patient desires.

In addition, technology-driven outpatient physical therapy has provided new levels of flexibility in scheduling patients that opens up capacity for those patients that need the resources that can only be found on the health system's campus, or in a physical therapy clinic.

Q. The precise movements and exercises involved in physical therapy rehab can be difficult for a patient to accomplish remotely. It seems a provider on a video call can be about as valuable as a YouTube video. How do physical therapists via telemedicine get past this limitation?

A. Not every PT visit is created equal – even within a single course of treatment. Some patients naturally require the in-person, in-facility sessions, including all the associated equipment, space and supervision. Others can work with a therapist in the comfort of their own home. Minimal equipment is needed and the context of assessing, treating and exercising in the home setting actually enhances the experience.

In other cases, the patient has previously learned routines under supervision, and a televisit may be appropriate. In these cases, a therapist is well positioned to monitor patient performance – observing movements and providing real-time feedback.

And then there are what I'll call the "Peloton cases," which may be related to mobility or range of motion issues, in which the patient has performed most of the exercises before, and all they need is maintenance-level exercise. These on-demand sessions are convenient, allowing the patient to complete the routine when and where they want, with guidance provided via video.

Technology should not replace care, but enhance it and improve outcomes, and the complexity of rehabilitation needs can limit the scope of what we can achieve via video.

YouTube and online videos are a one-way communication – patients can see the movements, but there's no feedback provided as to whether they are doing them correctly, no personalization based on the patient's personal health or circumstances, no ability to ask questions, and no ability for a professional to track their progress or change the PT care plan if necessary.

Q. How can providers use technology to help match their patients with real physical therapists without a need to drive and go to a clinic?

A. The Luna technology-enabled approach that EvergreenHealth has adopted matches a patient's needs with a therapist's specialties and availability. The platform automates this matching and scheduling – even calculating drive times with traffic and seasonality adjustments – and optimizes the routes therapists take to help them be as productive as possible.

Patients can use an app to schedule and manage visits, message their therapist and use their insurance to pay.

Therapists can use their app to eliminate manual post-visit charting. The app prompts the therapist to make a phone call, and an automated system then asks a series of targeted questions, and the platform creates a digital patient-chart for review and approval.