Telerehab: What’s the Fuss?
Can virtual physical therapy really be an effective alternative over in-person care? A test session revealed the answer.
Telehealth is a popular topic in the world of workers’ comp. It’s been touted as a way to reduce missed appointments by bringing providers right into patients’ living rooms, cutting out the need to travel or find a ride, and saving time in the process. This should translate into better outcomes for injured workers and lower costs for employers and payers.
Most of us would agree that seeing a doctor right from your couch is more convenient than making your way to an office and having to kill time in the waiting room. But skeptics have questioned whether quality care can really be delivered within the limitations of video conferencing. Separated by screens, can clinicians see their patients well enough? And in the case of physical therapy, how can they administer treatment without the ability to touch their patient?
I tested a telerehab platform to see if virtual PT can really be an effective mode of care for injured workers. Here’s what I learned:
1. Virtual treatment can work for more than just soft-tissue injuries.
While it’s true that not every injury is suitable for virtual care, any injury that inhibits movement can be improved through a telehealth platform.
“Pretty much anything non-surgical makes sense,” said Michelle Despres, Vice President, National Product Leader, One Call. “Injuries that are muscular or skeletal in nature can be treated in this setting, but post-surgical rehabilitation and even chronic pain can also be addressed.” One Call is one company in the workers’ comp arena providing technology to payers that connects injured workers to qualified, independent therapists.
Injuries that need to remain immobile in order to heal — like an open wound or fractured bone — would be unsuitable. But “as long as a person is cleared for active movement, that person would be a fine candidate for a telerehab platform,” Despres said.
I connected with Aideen Turner, my virtual physical therapist for the day, via smartphone as she conducted an assessment for neck and shoulder tightness. Turner works with Virtual Physical Therapists LLC, one of the independent telerehab providers that partner with healthcare networks to bring their services to the patient.
She explained how she and other virtual PTs are trained to look for inhibited range of motion of even a few degrees.
“The therapists are trained in mechanical diagnoses and treatment. They evaluate based on function and movement patterns. What used to be done by touch and feel can now be done by cueing movements for the injured worker and watching how their bodies respond,” Despres said.
In my case, running through a series of movements like turning the head from side to side and up and down revealed some tightness in the left shoulder and neck area. Turner could then recommend a few specific stretches and postural adjustments that would loosen the area and prevent it from getting worse.
2. The technology is easy to use.
All an injured worker needs to access a telerehab platform is a smartphone and WiFi access. After setting up a user account on the Virtual Physical Therapists app, accessing a scheduled appointment was for me a two-step process — opening up the app and clicking on the “Appointments” tab.
Most telehealth platforms are designed to be intuitive and user-friendly.
When the primary benefit is convenience, a clunky or difficult user interface would only sabotage its effectiveness.
One would wonder, though, if less tech-savvy users would feel more comfortable seeing a therapist in person. Despres and Turner, however, said that even patients less comfortable with technology have been enthusiastic about the convenience factor of virtual platforms and reported no technical issues.
“Almost everyone has a smartphone. It’s safe to say that the learning curve associated with these devices has been well-surpassed,” Despres said.
3. It saves time and avoids scheduling stress.
The biggest benefit of using a virtual physical therapy platform is convenience. Traditional, in-person appointments can be difficult to fit into a normal workday schedule. An injured worker’s employer may require them to clock out for an afternoon appointment; accounting for travel time and an hour-long visit, that worker could lose two hours of his work day. Avoiding that scenario means scheduling an appointment before or after work hours, but many clinics do not have schedules to meet that need.
Virtual therapists are often available as early as 6 a.m. until 10 p.m. Patients may also be able to complete their appointment from their workplace. A quiet conference room with a good WiFi connection may be all that’s needed.
In addition to removing scheduling stress, that flexibility can contribute to better care by facilitating a faster first appointment and increasing the likelihood that patients keep appointments. Appointments in this format also tend to be more efficient.
“Virtual appointments generally last 30 to 45 minutes. They’re laser-focused. As you move through the appointment there’s no ice or heat applied, no electric stimulation, no ultrasound. They hone right in on the problem that needs to be addressed and address them immediately. This format is better suited to speed. You typically don’t need a full hour appointment,” Despres said.
4. It sets the foundation for long-term health.
As I wrapped up my session with Turner, she demonstrated correct posture and several stretches to prevent and correct muscle imbalances that typically arise in workers who spend their days hunched over keyboards and computer screens.
Much more so than with traditional care, virtual care includes a larger educational component. Because the therapist is not physically present to assist with movements or joint stabilization, the onus is much more on the patient to learn these techniques and practice them continually.
“Self-management is a big factor. But that can translate into faster recovery. Instead of a patient practicing these movements three times a week with their therapist, they are encouraged and enabled to do them three times a day on their own,” Despres said.
“You’re taught to identify your symptoms, to connect your symptoms to movements, and to self-mobilize.”
Other Surprising Benefits of Virtual PT
As with any new technology, employers are slow to adopt virtual health platforms; they first want to understand its use cases and whether it will bring additional benefits they haven’t seen before. Even in its early stages, however, virtual PT is producing some surprising results that may result in significant cost savings for employers and workers’ comp payers.
With the ability to schedule appointments faster, telerehab platforms enable a “PT-first” approach, which can cut down on unnecessary (and expensive) diagnostic testing.
“We had a gentleman who worked in an office experience a shoulder injury. He had an MRI before he started therapy, which showed a small tear. Well, a tear is a fairly common occurrence in our shoulders. After three virtual PT visits, he was 100 percent functional and felt fine,” Despres said.
“But the fact that this word ‘tear’ was officially diagnosed in his MRI report… it made him fearful. It made him feel like this is a big problem to be fixed, and this is the kind of thinking that can lead to surgery when surgery may not be the best route. It’s often better to try PT first to see if that makes a difference before taking more drastic measures. Our experience using a telerehab platform has shown that.”
Virtual platforms have also proven effective at addressing chronic pain — something no one was expecting.
“When we first conceptualized what telerehab looked like, we didn’t think chronic pain patients would be good candidates. They’ve been experiencing pain for a long time, there’s a lot going on — we thought they’d benefit from a face-to-face interaction,” Despres said.
“But we’ve learned that virtual PT actually can provide a greater degree of one-on-one attention. Many patients have said ‘Wow, this is the first time I’ve had someone’s attention for a full 30 to 45 minutes.’ And suddenly their care takes a turn.”
At a time when healthcare providers are searching for alternative chronic pain treatments that don’t involve addictive painkillers, this result demonstrates that virtual PT is an effective option.