“If you’re going to do it, do it right, baby.”
George Michael was NOT thinking about telerehabilitation when he penned those words. Indeed, at the time telerehabilitation would have been the stuff of a sci-fi novel.
Times have changed.
These days, telerehabilitation is increasingly popular among physiotherapists, with members contacting the College of Physiotherapists of Alberta on a regular basis with questions about how to incorporate telerehabilitation into their practice. Broadly speaking, telerehabilitation is “the remote delivery of physiotherapy interventions mediated by communication technologies.”1 Examples include video conferencing and telephone consultation services, with new methods and approaches emerging daily.
Why all the hype about telerehabilitation?
When it comes to access to physiotherapy services, the disparity between rural and urban settings is not news. The proportion of physiotherapists living in urban areas has been greater than the proportion of physiotherapists working in rural settings for many years.2 Furthermore, physiotherapists working in rural settings are often called upon to be “generalists” treating a wide range of conditions, meaning that patient access to care from physiotherapists who focus their practice and develop additional skills in a specific area of practice can be very limited. Telerehabilitation enables the delivery of services over large or small distances3 and in some cases, across borders.4
Telerehabilitation isn’t all that new either. Alberta Health Services has had telehealth facilities in place throughout the province for many years, using the systems to deliver continuing education to staff, hold meetings, and deliver patient care.
What has changed is that the increased availability of telerehabilitation platforms and technologies at a lower cost has led to an increase in use by private practice physiotherapists, enabling them to provide services remotely and address physiotherapy access issues. In recent years a growing body of research has emerged that points to the ability to reliably and accurately perform certain components of physiotherapy assessment and intervention without being physically present with the patient.5 The combination of improved access to technology, and research to support the use of technology to deliver physiotherapy serves to encourage the uptake of telerehabilitation by a range of physiotherapy clinicians.
Before you jump on the bandwagon…
Telerehabilitation seems to be the hot new trend, but like all trends, it deserves some scrutiny before you sign up. One of the touchstones of telerehabilitation is that services delivered using these technologies need to meet the same expectations and standards for quality, competent care as services delivered in person.1 Depending on the population you serve and the type of practice you have, this may or may not be feasible. For example, patient education and supervised exercise/exercise prescription are two interventions that may be easy to deliver to certain patient populations using telerehabilitation technologies. In contrast, it would be impossible to deliver interventions such as spinal manipulation or needling via telerehabilitation.
Is telerehabilitation a good fit for you, the patient population you serve, and the type of interventions you typically deliver?
Even if you decide that telerehabilitation is a good fit, you also need to consider if you are competent to deliver services in this way. As a College, the College of Physiotherapists of Alberta views telerehabilitation as a new way to deliver physiotherapy services, not a new service. None-the-less, physiotherapists will need to develop new skills to use the technology accurately, efficiently and effectively. This includes both the technical skill to work with the telerehabilitation platform or system, and the clinical skill to use the technology to deliver services.1
How will you develop these skills? What training or resources are available to support your implementation of telerehabilitation?
As stated earlier, telerehabilitation services need to meet the same expectations and standards as services delivered in person. There is only one set of Standards of Practice for the profession. The Standards are written in broad and encompassing terms to try to address the needs of the full range of practice settings and patient populations that physiotherapists work with. This sometimes means that additional direction about how to meet the expectations outlined in the Standards is needed. The College of Physiotherapists of Alberta has created a Telerehabilitation Resource Guide to address the specific concerns and considerations related to telerehabilitation practice that physiotherapists should consider.
While issues such as privacy, consent and safety are important to physiotherapists in all practice settings, the guide helps to identify specific concerns arising from telerehabilitation practice in these and other domains, and to identify necessary steps to address these concerns.
You can find the Telerehabilitation Resource Guide here. The guide is a tool to help you to follow George’s advice and “do it right”.
- Physiotherapy Alberta – College + Association, College of Physiotherapists of Manitoba. Telerehabilitation Resource Guide for Alberta Physiotherapists. 2018. Available at https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/telerehabilitation_guide. Accessed April 18, 2018.
- Sutherland, Greg. The Market Profile of Physiotherapists in Canada. Ottawa: The Conference Board of Canada, 2017.
- Federation of State Boards of Physical Therapy. Telehealth in Physical Therapy: Policy recommendations for appropriate regulation. Available at: https://www.fsbpt. org/Portals/0/documents/free-resources/ TelehealthInPhysicalTherapy2015.pdf. Accessed January 31, 2018.
- Canadian Alliance of Physiotherapy Regulators. Memorandum of Understanding: Cross Border Physiotherapy. Available at: http://www.alliancept. org/wp-content/uploads/2016/03/MEMORANDUM-OF-UNDERSTANDING-Cross-Border-Signed-x-10-May-16- 2017-EN.pdf. Accessed January 31, 2018.
- Russell, T. Tele-rehabilitation in Physiotherapy Practice. [Recorded Webinar]. Physiotherapy Alberta. April 2017. Available at https://www.physiotherapyalberta.ca/xchange/continuing_professional_development/elearning_center/tele_rehabilitation_in_physiotherapy_practice/?course_type%3Alist=Recorded+Webinar&search_term=russell. Accessed April 18, 2018.
