How Telehealth is Used in Physical Therapy

When Covid became a public health emergency, everything changed. To decrease the risk of transmitting the virus to patients and healthcare workers, clinics and hospitals began to defer elective and preventive care visits such as PT.

With no end to the crisis in sight, putting off non-emergency care indefinitely was not a long-term solution. It quickly became clear that telehealth would be an ideal avenue for patients to continue receiving non-emergency care.

So, federal and state governments temporarily relaxed telehealth restrictions to ensure patients needing non-Covid-related healthcare services, such as PT, could still get the help they needed without visiting already overwhelmed hospitals and risking exposure to the virus. 

In response, hospitals and healthcare providers implemented telehealth infrastructure and began offering remote appointments with providers. By 2021, 48 percent of physical therapists provided telehealth services to their patients. 

While these measures were initially seen as temporary, both patients and providers have gleaned unique benefits that telehealth can provide.

We spoke to two physical therapists who regularly offer telehealth to clients about what to know about virtual PT.

Dr. Cheng and Dr. Kummerle started offering virtual PT for the first time near the pandemic’s start.

“I saw how breakouts were happening in Seattle and convinced the clinic I was working [in San Francisco] at that time to get Zoom so we could transition to online care,” Dr. Cheng says. “Covid pushed physical therapy and the rest of the medical professions into online care out of necessity.”

Although Dr. Cheng says fewer elective surgeries were being performed during the peaks of Covid, individuals were still seeking PT for injuries and other health conditions that benefit from PT. Video-based appointments allowed patients to receive preventative care and PT for chronic conditions.

In Florida, where Covid-era restrictions on social activities were some of the most relaxed in the nation, rates of infections were high. Many hospitals were at or over capacity in the summer of 2020, causing non-Covid cases to take a back seat at in-person healthcare settings.

“I think [Covid] was the push that PT clinics and also patients needed to offer it as a service and to accept it as something that could help,” Dr. Kummerle says.

In a 2021 study, researchers found that telehealth physical therapy is effective for various health conditions and patient scenarios. Another study found that patients were happy with the medium of care; satisfaction rates with virtual PT were comparable to in-person treatment—and some patients even preferred telehealth over traditional in-person treatment.

 Let’s take a closer look at some additional benefits virtual PT offers.

Expanded Access to Care

For patients who live in healthcare professional shortage areas and rural areas, having a virtual option may be the only feasible option for receiving care.

“If you live an hour from the closest town, it’s a huge barrier to spend two or three hours round trip seeing a physical therapist,” Dr. Cheng says. “[Telehealth] opens up the option of PT to so many more people, especially those who live far away or just have busy lives.”

Even people who live in populous areas may have difficulty establishing care with a PT due to the shortage of providers. A 2022 report from APTA found that on average, outpatient PT providers were operating with staff vacancy rates of about 16 percent, limiting clinics’ ability to meet patient demand.

“We’ve also used [telehealth] to help [compensate for] the increase in wait times for an in-person evaluation,” Dr. Kummerle says.

“Scheduling can be another benefit as oftentimes therapists may offer different hours versus the hours that the clinic is open, so if your work or life schedule is busy, it may be easier to fit in a telehealth visit versus a clinic visit based on the schedule and commute time,” she adds.

Patients that are simply more comfortable receiving PT from home—whether due to a physical disability, a mental health condition, or a personal preference—also have better access to care thanks to telehealth.

Improved Continuity of Care

Having the option of telehealth on the table can also support continuity of care, which is important in PT because consistency affects patient outcomes.

For example, the timeliness of PT rehabilitation—i.e., getting care immediately after a surgery or injury and consistently seeing your PT—is essential for promoting functional recovery after a stroke.

Additionally, patients receiving more consistent care after an injury have a lower chance of undergoing surgery to address the issue later. 

However, barriers to continuity can prevent patients from achieving optimal rehabilitation results. When life gets in the way, having a virtual option can make or break continuity of care.

“It can be a great option to provide patients if they or their family are feeling a little sick but could still participate in PT that day,” Dr. Cheng says. In these scenarios, rather than missing a session, a patient can log on to their computer and still complete their PT.

Certain patients may even be able to complete their full course of treatment virtually, depending on their health condition and care needs, Dr. Cheng says.

Reduced Cost of Care

According to a study from 2020, virtual PT can significantly lower healthcare costs and provide similar effectiveness to in-person care.

“Insurance copays and co-insurances would stay the same based on the agreed rate, but depending on the company, some may charge less for cash-based telehealth versus cash-based, in-person physical therapy,” Dr. Kummerle says.

“It may also allow you to increase your frequency of visits due to not having to travel or scheduling, which can improve outcomes and reduce the overall number of visits and duration of care, which can result in an overall lower cost to the patient,” she says.

PTs may also be able to save money by offering virtual appointments. 

“The largest non-personnel cost for any PT clinic is the facility [and] rent,” Dr. Cheng says. “If you provide exclusively virtual care, you could do that from your own house, decreasing the cost of rent overhead.” These savings are passed along to the patients, as well, Dr. Cheng says.

Of course, there are some limitations to seeing a PT virtually. Telehealth is not appropriate for every patient and every health condition.

Manual therapy, e.g., soft tissue interventions, dry needling, and joint mobilizations and manipulations, must be done in person. 

“A good 25 to 50 percent of my treatments are manual therapy-based, meaning I’ll use my hands or some modalities to work soft tissue or joint restrictions,” Dr. Cheng says.

“Manual therapy techniques are best for when patients are experiencing more acute pain. But as they get out of the painful phase, they’ll transition into mostly movement-based treatment,” which is suitable for video-based PT, Dr. Cheng says.

“You can work with a wide variety of injuries and conditions safely over telehealth, but if safety is a concern with exercises [for example] a patient who is a fall risk, in-person physical therapy may be more appropriate,” Dr. Kummerle says.

The efficacy of virtual PT also depends on the provider’s ability to adapt to the video-based format.

“Being a good virtual PT is a bit different than being a good in-person PT,” Dr. Cheng says. “To create a meaningful and effective experience for the patient, you have to change how you assess and treat.”

Here are some best practices for providing virtual PT:

• Prepare your patients: If you have the resources, designate an administrative staff member who can connect with patients before the initial appointment to advise them on downloading any necessary software like Zoom (or your clinic’s telehealth platform) and adjusting their computer’s video and microphone settings.
• Prepare your space: Make sure your space is quiet, well-lit, and has minimal background distractions so your patients can clearly see and hear you during sessions.
• Avoid Internet connection problems: Connect directly to your Internet router with an ethernet cable to avoid disruptions and lagging caused by WiFi.
• Prepare equipment and practice: Get organized before your appointments so all of your equipment is at your fingertips. Then, practice different angles with your webcam to capture different movements and exercises. This way, you don’t have to experiment and waste time during the session. This may require an adjustable webcam stand with a flexible neck.

In the words of the American Physical Therapy Association (APTA), “It’s an important moment for the physical therapy profession”—a simple yet apt description of the current state of affairs.

On May 11, 2023, the U.S. announced the end of its pandemic crisis response. The statement comes as a relief because it means the worst of the public health emergency is over, but also begs the question of whether or not the Covid-era regulatory flexibilities that providers and patients have become accustomed to will continue. 

The evolution of insurance coverage and reimbursement regulations are still yet to be determined following the pandemic. But it’s safe to say that the genie is out of the bottle when it comes to telehealth.

Suppose the federal government rolls back Covid-era changes. In that case, states may start changing their own telehealth policies to ensure that patients and providers can continue to utilize teletherapy to the same extent. 

The silver lining of the pandemic was its opportunity to demonstrate the value telehealth physical therapy can offer. Hopefully, this is the beginning of a permanent expansion in healthcare.