To many, it may feel like the pandemic closures thrust physiotherapists and patients into a new world of virtual/online care that took many by surprise. But virtual physiotherapy (also known as telerehabilitation) has been an option utilized and researched in physiotherapy for quite some time prior to the onset of COVID 19.1
There is good research to support its use in providing services to rural and remote communities2 and that it can be safely and effectively applied with positive experiences for both the patient and the physiotherapist.3
There are definitive positives around accessibility and convenience, however; there are a few things to keep in mind if you are using virtual physiotherapy, as some injuries or conditions would be better evaluated or treated with in-clinic appointments.
Now that the dust has settled and many of us are attempting to return to a routine life again it is worth while taking stock of what is now considered to be a more common way to provide physiotherapy services. This article will explore the pros and cons of your potential virtual visit.
The Potential Upsides
Accessibility is the top of the list of potential benefits of virtual services. If you live in a remote part of Alberta, you may have struggled in accessing equitable health care. Canada is a massive country and once you move away from the oceans and borders the population thins out dramatically. There are parts of Alberta that have difficulty recruiting and retaining physiotherapists or other health-care professionals, and this leaves patients with limited options for care of their injuries or conditions. Accessing physiotherapy services virtually from a provider in a nearby town or a large city farther away creates an opportunity for the patient to gain access to having their injury or condition appropriately assessed where no services previously existed.
It’s also possible that by accessing virtual physiotherapy services a concern may be identified that is not appropriate for virtual physiotherapy or which may necessitate referral to a different health-care provider for assessment or care. While this may not be what you hoped, this is overall a good outcome, as it ultimately helps you get access to the care you need, something that may not have happened, or which may have been delayed prior to the increased acceptance of virtual care.
For those who do have physiotherapy services in their geographical area, virtual physiotherapy may still be a preferred choice to access care. There is an element of convenience to this mode of delivery for those who see in-clinic care as a barrier. For some, their lives are increasingly hectic, and they are unable to attend appointments in-person due to work schedules or family obligations. Some struggle with limited ability to travel whether due to transit costs or time, mobility impairments or mental health concerns. Whatever the reasoning, the idea of getting out of work or leaving home to attend physiotherapy appointments can be a barrier to seeking help for an injury. Physiotherapists being able to offer appointments to you in your office or home can remove that barrier to care and enable access to services.
As stated previously, there is research that demonstrates that physiotherapy services delivered virtually can be effective.1,2,3 Although most think of physiotherapy as a hands-on profession there is quite a lot that physiotherapists can do to assist you without putting their hands on you to assess and treat your injury or condition. Physiotherapists are able to ask you questions regarding your injury, overall health, and identify barriers you may be experiencing in your recovery. Most often after the questions they will have a pretty good idea what is going on and how they can help. The hands-on assessment will obviously be different but there are many ways the physiotherapist can complete an assessment virtually. You can move and activate muscles, show them what movements create the pain or limit you, find where its tender to touch, etc. for them to come to a diagnosis.
Once they have been able to identify the area of injury, they can provide corrective exercises via software that have pictures, videos, and descriptions that you can easily follow along with at home. There is also educational material that you can access that builds on what the physiotherapist was able to guide you through in your appointment. All of these are there to assist you in your recovery and are effective ways to treat most injuries.
The Potential Downsides
Privacy & Confidentiality
With all electronic and digital communication there is potential for data to be hacked or stolen. The requirements to provide virtual services is for there to be adequate electronic security. Each provider is required to have technology or software in place that is sufficient to protect the patient’s private information during their online interactions.
Apart from what occurs digitally there is the practice setting to consider. The physiotherapist is expected to be providing services from a location that creates privacy and not from their local coffee shop or their family’s kitchen. You as a patient should also think about where you are receiving your virtual physiotherapy. Do you want people to be able to listen in or see what you are doing? Your office space may be a cubicle or be glassed in where your office mates can see you or potentially hear you. Or you could be at home with your family or roommates but maybe you would still like some privacy to discuss health matters.
The other consideration is that access to high-speed reliable internet might be limited in your community so potentially your only point of access could be the local library, which may not offer the level of privacy you would like. These are factors you will have to weigh as you consider whether this mode of delivery works for you.
Safety and Risk Management
What happens if there is an accident while you are online with your physiotherapist? The safety concerns for virtual appointments are unique to your injury, your location and your support network during your online physiotherapy appointment. It is important to have a plan in place so that if something occurs you can be attended to appropriately. Some common potential issues would be a fall or fainting. Do you have someone in your space that can help you (someone at home, friend at the office?) and if you do need help can you notify them or does the physiotherapist have access to your emergency contact information? Does your physiotherapist know your location so that they can alert emergency medical services to your location if you need medical aide? These are things that each physiotherapist and patient should work on together to try and make your interactions as safe as possible.
Meeting Your Needs
A large part of receiving services in this manner is whether or not your injury or condition is appropriate for virtual care. Your physiotherapist may ask you to come into the clinic so that they can assess something they are unsure of, or if you aren’t improving as expected they may ask you to come in to re-evaluate your injury. We discussed that after the physiotherapist completes their questioning and assessment, they may think that you are not a good candidate for virtual services because of the assessment findings.
Sometimes if the barriers to being in the clinic are too great (distance, disability) then you and your physiotherapist may agree with the limitations encountered. It is important to remember that you should be advised of the limitations and risks related to virtual services, to allow you to make an informed decision about continuing in this manner.
Where is your physiotherapist located?
One last item to discuss is around the regulation of physiotherapy services. If your physiotherapist is interacting with you from outside the province of Alberta, they must be registered in Alberta. The reasoning behind this is so that we can identify who is providing services and can hold them accountable so that they are providing safe, effective care to Albertans. You can easily access our website and go to Verify a Physiotherapist to find out if your physiotherapist is actually registered in the province and able to provide you with the care you are seeking. If they are not registered in Alberta, you may not know if they are qualified to provide physiotherapy, or if there are any conditions on their licence to practice in another province or country.
Hopefully this article has given you a better understanding of the pros and cons of virtual physiotherapy. Its important to remember that both you and the physiotherapist have a role in creating an experience that allows for quality, safe and effective care.
To ensure safe, effective and quality care, anyone using the title physiotherapist, physical therapist or P.T. in Alberta must be registered with the College of Physiotherapists of Alberta. Use our Verify a Physiotherapist feature to confirm you're receiving treatment from a registered physiotherapist.
- Pamela Seron, PT, PhD, MSc, María-Jose Oliveros, PT, MSc, Ruvistay Gutierrez-Arias, PT, MSc, Rocío Fuentes-Aspe, PT, MSc, Rodrigo C Torres-Castro, PT, MSc, Catalina Merino-Osorio, PT, MSc, Paula Nahuelhual, PT, MSc, Jacqueline Inostroza, PT, MSc, Yorschua Jalil, PT, MSc, Ricardo Solano, PT, MSc, Gabriel N Marzuca-Nassr, PT, PhD, Raul Aguilera-Eguía, PT, MSc, Pamela Lavados-Romo, PT, MSc, Francisco J Soto-Rodríguez, PT, MSc, Cecilia Sabelle, PT, MSc, Gregory Villarroel-Silva, PT, MSc, Patricio Gomolán, PT, MSc, Sayen Huaiquilaf, PT, Paulina Sanchez, PT, Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview, Physical Therapy, 2021;101(6)
- Jitendra Jonnagaddala, Myron Anthony Godinho, Siaw-Teng Liaw. From telehealth to virtual primary care in Australia? A Rapid scoping review. International Journal of Medical Informatics. 2021;151
- Kim L Bennell, Belinda J Lawford, Ben Metcalf, David Mackenzie, Trevor Russell, Maayken van den Berg, Karen Finnin, Shelley Crowther, Jenny Aiken, Jenine Fleming, Rana S Hinman. Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: a mixed-methods study. Journal of Physiotherapy. 2021;67(3) 201-209