The COVID-19 pandemic has forced changes to the ways we do most things. Practicing medicine was not an exception, and this includes outpatient physical therapy. While traditionally a very “hands on” practice, physical therapists have been forced to adapt the methods by which they deliver their services. This includes the option of performing physical therapy virtually through a telehealth platform. While most PTs, particularly manually trained therapists, agree that this is not the most optimal delivery model, telehealth options have shown themselves to be an adequate substitute during these unprecedented times.
While there are sure to be numerous outcomes studies performed down the road to compare the overall effectiveness of virtual physical therapy versus in person, we are already seeing some data published related to patient satisfaction. An October 2020 study in HSS Journal by Eannucci et al found that there was not a significant difference in the overall patient satisfaction when comparing patients that received PT in person versus via a telehealth platform. There was a slight difference in the reported satisfaction in achieving treatment goals, however, this was relatively minimal, and likely not clinically significant in terms of functional outcomes.
In another study published in January 2021 in Physical Therapy, Miller et al found that 94% of patients following 4,548 sessions of telehealth physical therapy reported overall satisfaction, with 92% of the patients reporting they would do virtual PT again. An encouraging component of this study was the large scope of patient variability; both in diagnosis (orthopedic conditions, neurologic, pelvic health, and “unspecified”) and payer mix (Commercial, Medicare, Medicaid, and Worker’s Compensation). A limitation of this study, similar to the Eannucci study, was the lack of clinical effectiveness measures evaluated, leaving the question “is telehealth/virtual therapy as effective as in-person treatment” still unanswered.
While more studies related to virtual physical therapy and patient satisfaction are likely to be performed, (and hopefully some studies that focus on clinical outcomes) it’s worth noting that physical therapists have demonstrated great adaptability throughout the pandemic, and even managed to find ways to strengthening their clinical skillset, despite not treating patients “in-person.”
As therapists were forced to rely less on their “hands-on” treatment interventions, opportunities to hone in communication skills abounded. As clinicians adjusted to the new normal of COVID-19, providers have reported that utilizing telehealth PT has strengthened their ability to communicate with their patients while enhancing their subjective examination skills. In a December 2020 editorial in the Journal of Orthopaedic and Sports Physical Therapy, Lewis et al argued that the pandemic forced physical therapists to provide care that was primarily active, helped focus patients on self-efficacy and self-management, and is far less reliant on passive therapies.
This increased emphasis on communication and patient self-management of pathology will serve PT’s well as we come out of the pandemic, as providers may become less focused on what we can do to help the patient with manual therapy techniques, and more focused on how the patient can help themselves with our guidance (pain science, exercise, education, biopsychosocial approach, etc.).
Ultimately, the COVID-19 pandemic has posed numerous challenges to the physical therapy profession, and PTs should be proud of the way they have adapted their practices to continue to deliver quality care to their patients. The implementation of telehealth PT, while perhaps not optimal compared to traditional therapy, has allowed PTs to continue to deliver care with high levels of satisfaction to their patients.
In addition, the profession has gained some insight on how to be effective, even under the most challenging of circumstances. While we may still be months away from returning to “normal,” I think it’s fair to say that the challenges brought to PT’s by COVID-19 will allow us to come out the other side better providers, with new skills by which we can continue to positively impact the lives of our patients. In the meantime, those who still rely on telehealth as a means to manage their conditions should continue to be satisfied with the interventions they receive, despite the circumstances.
