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TeleHealth: The New (Temporary) Norm

Written by Stephanie Lievense, PT, DPT, OCS

In this day and age, it is not uncommon to work virtually. With today’s technology, we can work from just about anywhere. When I say “we,” though, I don’t include myself or most physical therapists. Some physical therapists have moved into more administrative roles, which means that they are involved in little to no direct patient care. However, most of us depend on treating our patients in person. As doctors of physical therapy, we rely quite heavily on our hands to give us the information that we need when treating a patient. Yes, the subjective information and observations are crucial, but our hands can give us important clues such as a joint restriction vs a muscular restriction or acute swelling vs pitting edema.

Since the COVID-19 outbreak forced most outpatient physical therapy clinics to close, we have had to quickly shift our method of care to the virtual side. We call this TeleHealth, which means that we hold sessions with our patients via video, such as Zoom or Skype. In a TeleHealth session, we do everything that we would in a normal session except put our hands on the patient. We can watch our patients walk, squat, balance on one foot, and do their home exercises. We can also instruct our patients in new exercises and show them how to use certain equipment. We are able to educate and answer any questions that the patients may have about their plans of care or symptoms. We can inspect a wound, especially if it is a recent post-operative case, and advise wound care accordingly. Finally, in some cases such as a total knee replacement, we can even instruct the patient’s family member/spouse/caregiver in safe mobilizations to perform so that the joint does not get too stiff while out of therapy.

From my recent experience with this shift in care, I can tell you that the need for TeleHealth truly depends on the patient. Some patients require a significant amount of manual therapy during their sessions due to factors such as mobility restrictions, high pain levels, and abnormal neurodynamics. Therefore, these patients typically find more value in hands-on techniques. Obviously we cannot offer hands-on therapy with TeleHealth, so these patients tend to prefer to wait until they can see a therapist in person. On the other hand, some patients’ sessions may consist of mostly exercises. You’re probably thinking, “Can’t they just do them on their own?” Well, maybe – you’d be surprised at how many people prefer to have a set time with supervision to make sure not only that they are doing their exercises, but that they are receiving feedback on their technique. 

So, how do you know if TeleHealth will benefit you? Here are some things to consider when looking into a TeleHealth session with a physical therapist:

 

You are a current patient 

This is a no-brainer. If you were being treated at a physical therapy clinic and it had to close for COVID-19 precautions, then you are technically still under the care of your physical therapist. I know I speak for all of us when I say that your physical therapist does not want you to regress and wants to know how you’re doing. If you were being treated regularly (1-2 times per week or every other week) and it has been more than one week since your last visit, you might want to consider checking in with your therapist. 

Your questions for your therapist require an email chain

If you have been or are a physical therapy patient, then you know that your therapist is always available for questions via email. This is especially true now that we are always home! However, if you find that you are having to ask multiple questions that elicit lengthy explanations from your therapist, then a 30-minute TeleHealth session may be well worth your time.

Your symptoms have worsened or you have new symptoms 

This is important. Even though we can’t touch you, we can certainly listen to and observe you much better on video than through email or on the phone. Point to the location of your symptoms, describe them, tell us what makes them worse and/or better, and move around for us. When I did my orthopedic residency, I was actually taught that your patient’s history should take up most of your evaluation because that is how you determine if your patient belongs in your clinic and not back at the doctor’s office or emergency room. Hopping on a video session with us could mean the difference between simply needing new exercises and a call to your physician for an urgent condition.

Your home exercises are causing more pain, they are too easy, or they are too hard

Did we give you new home exercises before our clinic closed? If so, we haven’t had a chance to touch base with you on how they’re going because that is what we’d normally do at our next in-person session. We always tell our patients that your home exercises should not make your symptoms worse – if they do, we need to make some changes. This is where a TeleHealth visit comes into play. Show us on video what you’ve been doing, and we can give you verbal cues to help your form, show you how to modify your exercises or make them more challenging, or say, “Scratch that, this may not be a good one to do yet. Here’s what you can do instead.”

You want to get in a quality workout while “social distancing” but aren’t quite sure what to do

We understand that people usually come to physical therapists to help with or cure pain. However, that doesn’t mean we can’t bring it….as specialists in exercise and movement, and even as former athletes ourselves (many of us!), we are very familiar with different types of workouts and how to alter them based on your goals and your current level of fitness. Not only can we help you with a specific workout routine, but we can also help you with a sample workout schedule to keep you from overtraining and hurting yourself.

 

Disclaimer: this is NOT to sell you on TeleHealth visits. Again, the need for TeleHealth is very specific to you as a person and as a patient. This post is to help educate you on the concept of TeleHealth and help guide you in the right direction depending on your needs during this crazy time. 

Still stuck? We are always here for you via email – feel free to reach out to any of our therapists and they are all more than happy to help you decide if TeleHealth is right for you.

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