Telehealth for Physical Therapy is an Effective and Viable Option for Patients

Since the pandemic, telehealth options have increased to allow patients to still receive their care while socially distancing themselves from other people. Though it has been years since the start of the pandemic, and more and more places have returned to in-person appointments, telehealth options are still a viable option for many people.

But what is telehealth?

According to the Health Resource Services Administration, telehealth is "the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration" (Lee et al., 2024).

While many people are familiar with going to clinics in their communities for their physical therapy, it is very possible to have physical therapy sessions via telehealth. Not only is it possible, but "research shows that telehealth-delivered physical therapy services for musculoskeletal and cardiorespiratory conditions and post-surgical patient rehabilitation provide equivalent, and in some cases superior, clinical outcomes when compared to traditional in-person services" (Davies & Lawford, 2024).

When I was a graduate student studying to become a physical therapist, telehealth wasn't really touched on as a potential setting. Then the pandemic hit and many providers across the healthcare spectrum had to pivot in order to maintain patient care. It was difficult, to say the least, if you didn't have the infrastructure already in place to do that pivot towards telehealth. Even though in-person visits have resumed almost everywhere, there are still plenty of benefits and advantages to telehealth visits.

Improves access to care

Telehealth allows those who live in rural areas to still be able to receive patient care. A rural community, per the US Census Bureau is "an entity that lies outside of metropolitan boundaries with those boundaries being defined as having a core county with one or more areas of 50,000 people and out-lying counties tied to that core county" (Snyder et al., 2022). In order to receive general healthcare, people may need to travel an hour or more to see their providers. If the care is more specialized, people may need to travel even further than that. That distance may just be traveling to another state entirely.

Telehealth also allows those who live in cities and suburbs to have greater access to healthcare. They may have difficulties going in-person to appointments due to lack of transportation, the increased cost of transportation, or difficulty with arranging child care. With telehealth, people can access their care without the need of leaving their residence.

Indirect cost savings to patients

Inflation has increased prices on practically everything. Telehealth allows people to potentially save money on transportation costs or arranging/paying for child care. Depending on a patient's job, utilizing telehealth may help keep people from requesting additional time off from work to go to their appointments.

However, telehealth is not completely without barriers to its usage. Due to the fact that telehealth uses electrical information, it is necessary for a patient to have access to the internet. This also requires access to either a desktop or laptop computer or a smartphone, especially if the patient needs to check emails for their home exercise programs or do a video connection with their provider. That is not always a guarantee that the patient will have that internet access, especially if they live in a rural area.

Even if a patient has access to the technology needed for telehealth, they may not be able to navigate it. I have had many patients who, even though they had a smartphone, did not know how to use it to create a video session. For some people, it is far easier to go to their appointments in person versus struggling to do so over video.

A patient's health insurance may not cover telehealth visits, if you are utilizing a telehealth clinic that accepts health insurances.

But how effective is telehealth? The American Physical Association (APTA) came out in 2020-2021 with an article titled "Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview." They looked at several systematic reviews and their studies.

Most common conditions treated in:

Cardiorespiratory: "coronary artery disease, heart failure, and chronic obstructive pulmonary disease (COPD)"

Musculoskeletal: "low back pain, hip arthroplasty, total knee arthroplasty, and osteoarthritis"

Neurorehabilitation: "stroke, multiple sclerosis, and physical impairment in children"

Other: obesity, diabetes, cancer

The majority of the population treated within these studies were adults.

When compared to in-person rehabilitation, telehealth rehabilitation fared either equivalent to in-person or, in some cases, performed with better results. Quality of life, pain levels, and functionality improved from telehealth, along with improved balance for neurorehabilitation through telehealth.

Telehealth can even work well for those who have pelvic floor dysfunction. A study in 2024 looked at a mobile telehealth program to treat urinary incontinence for women veterans at the VA. The program lasted for eight weeks with 56 daily modules. Within those modules was an "interactive behavioral program that delivers a multi-component protocol, including pelvic floor muscle exercises, bladder control strategies, fluid management advice, self-monitoring, and risk factor reduction" (Burgio et al., 2024). Each module was meant to take 10 minutes or less to complete.

The results from the telehealth program fell into the categories of accessibility and useability, content understandability and helpfulness, overall evaluation, and suggestions to improve the program. When it came to accessibility and useability, the veterans "emphasized the program's convenience and flexibility" (Burgio et al., 2024) as veterans were able to complete their modules whenever or wherever they were. As for the overall benefits the veterans received from the program, it was discussed "how the program increased their knowledge and awareness of UI and treatment options, promoted consistency in practicing behavioral therapy, strengthened pelvic floor muscles, and reduced urine leakage" (Burgio et al., 2024). As a pelvic health physical therapist, it is wonderful to hear confirmation that telehealth works for the population and conditions I treat.

You may be wondering how a telehealth visit for pelvic physical therapy may work, but it is very similar to what I would do if I was seeing my patient in person. In the beginning, a lot of education goes a long way. The reason is that people may not be aware that their habits may be contributing to their dysfunction and knowledge is helpful in changing that. You don't know what you don't know, and pelvic physical therapy helps you to understand how to navigate unfamiliar terrain.

I am a fan of telehealth, as it allows me to reach a wider range of patients throughout Nevada. It also allows me to schedule appointments during the evening and the weekends, providing more accessibility to those who work a Monday-Friday 9-5 type of schedule.

Alavar Pelvic Health Physical Therapy is offering virtual pelvic health appointments within Nevada. If you live outside of Nevada, we offer virtual coaching sessions.

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References

Burgio, K., Echt, K., Markland, A., Enemchukwu, E., & Williams, B. (2024). A mobile telehealth program for behavioral treatment of urinary incontinence in women Veterans: Qualitative evaluation of MyHealtheBladder. Journal of women & aging, 36(6), 475–491. https://doi.org/10.1080/08952841.2024.2401716

Davies, L. M., & Lawford, B. J. (2024). The time is now: Telehealth education and training in physical therapy. Brazilian journal of physical therapy, 28(2), 101063. https://doi.org/10.1016/j.bjpt.2024.101063

Lee, A. C., Deutsch, J. E., Holdsworth, L., Kaplan, S. L., Kosakowski, H., Latz, R., McNeary, L. L., O'Neil, J., Ronzio, O., Sanders, K., Sigmund-Gaines, M., Wiley, M., & Russell, T. (2024). Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association. Physical therapy, 104(5), pzae045. https://doi.org/10.1093/ptj/pzae045

Seron, P., Oliveros, M. J., Gutierrez-Arias, R., Fuentes-Aspe, R., Torres-Castro, R. C., Merino-Osorio, C., Nahuelhual, P., Inostroza, J., Jalil, Y., Solano, R., Marzuca-Nassr, G. N., Aguilera-Eguía, R., Lavados-Romo, P., Soto-Rodríguez, F. J., Sabelle, C., Villarroel-Silva, G., Gomolán, P., Huaiquilaf, S., & Sanchez, P. (2021). Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Physical therapy, 101(6), pzab053. https://doi.org/10.1093/ptj/pzab053

Snyder, K., Mollard, E., Bargstadt-Wilson, K., & Peterson, J. (2022). "We don't talk about it enough": Perceptions of pelvic health among postpartum women in rural communities. Women's health (London, England), 18, 17455057221122584. https://doi.org/10.1177/17455057221122584