Telemedicine for Physical Therapy: It Works!

Lisa Sandberg fractured her elbow in early April while on a walk with her husband. Following the injury, she needed help regaining strength, function, and range of motion in her arm. So she called Reena Sehgal, a physical therapist she’d used in the past. But rather than go to her in person — an impossibility during the coronavirus pandemic — the two women have been working together virtually for about an hour two times a week.

You may be wondering how physical therapy, which tends to require touching, stretching, manipulating, and putting pressure on someone’s joints and muscles, can take place via telemedicine, using a digital device such as a computer or smartphone. It’s a valid question, and something those in the industry have wondered about themselves.

On-Screen Assessments and Exercise Instruction Prove Doable

“At first, seeing patients virtually felt like roller-skating for the first time with your hands tied behind your back,” says Eric Robertson, a board-certified clinical specialist in orthopedic physical therapy and professor at the University of Southern California division of biokinesiology and physical therapy in Los Angeles and a spokesperson for the American Physical Therapy Association (APTA).

“I was very uneasy and saw challenges at every level. However, I quickly gained a vocabulary and set of assessment tools to efficiently assess patients. In other words, it was much easier than expected to apply the skills of physical therapy into this new environment,” Dr. Robertson says.

It helps that physical therapy isn’t just about touch. It often involves a lot of analysis of a person’s movements, followed by helping them do exercises.

Sandberg, a marketing executive in her fifties who lives in Princeton Junction, New Jersey, says her experience with remote physical therapy was pretty straightforward. “Reena usually sends me some exercises in advance with little video clips so that I can get an idea of the type of exercises,” she says. “Then when I get on the session with her on camera, she goes over the exercises with me and watches me as I do them, and she’ll often do them at the same time as I do.”

Research Shows the Effectiveness of Physical Teletherapy

Studies have demonstrated physical teletherapy’s efficacy. A report published in January 2020 in The Journal of Bone & Joint Surgery studied 287 people with a mean age of 65 who had undergone total knee replacement surgery. Half did in-office or at-home physical therapy, while the other half used the Virtual Exercise Rehabilitation Assistant (VERA) system, which uses 3D technology and a digitally simulated instructor to give exercise instructions and provide immediate feedback based on a user’s movements. The virtual PT group also received weekly telehealth visits with a live physical therapist, who created individualized therapy programs.

According to the report, those who used the VERA system were hospitalized less and able to be physically active more than those who used traditional physical therapy.

Remote Physical Therapy Becoming More Accessible

The Centers for Medicare and Medicaid Services is now allowing physical therapists in private practice to bill for their face-to-face technology visits. Various insurance companies have started covering physical therapy delivered via telehealth.

“It’s been a very quick and easy learning curve on both ends,” says Karen Litzy, a physical therapist in New York City who is also an APTA spokesperson. Dr. Litzy, whose patients range in age from 10 to 70, has used the Zoom platform for PT appointments since the coronavirus lockdowns began.

Much of her work involves watching the way people move and looking for faulty movement patterns or movement that exacerbates their symptoms, like pain, numbness, or tingling.

“Then the biggest thing we do is we create individualized exercise programs for those clients to do while we’re there and also on their own,” Litzy says.

Physical Therapy Is Helping COVID-19 Patients Heal

In addition to her regular clients, Litzy has been seeing a lot of people who are physically weak after being sick with COVID-19. Many had been hospitalized; others spent a lot of time in bed. She expects physical therapy to play a huge role in helping people overcome their post-COVID-19 ailments, which can impair their ability to move freely and walk, especially if they’ve been lying in bed for weeks or months.

“I think telemedicine is going to be a great new adjunct for the future,” she says. “I really think telehealth is showing PTs and all medical professionals what’s really important when it comes to patient outcomes and treating patients.” It’s also allowing people in rural areas, who often have to drive hours to reach a clinic, the ability to see a professional remotely.

What You Need for a Virtual PT Visit

So what’s needed for successful virtual physical therapy? According to Litzy, just a few basic items:

• A good internet connection
• Space to lie down, walk, stretch, and turn around, so your therapist can see how your body moves
• Good lighting

“We try to figure out the best camera angles,” says Litzy. “Once we figure out the layout of their place and the camera angles, it’s that much easier.”

For Sandberg, it’s been simple. Before hurting her elbow, she had started online physical therapy sessions for a herniated disk. “Reena had me on my Pilates reformer in my house and was working with me on exercises both on and off that machine,” she says. “It’s not so weird not having her touch me, because for this particular injury there’s no manipulation needed. She just needs to guide me through doing the exercises in the proper form. I can see her clearly on the computer screen and hear her well, so we haven’t had any technical difficulties. Most sessions consist of discussion of my flexibility and pain and ease of movement, and then we get into exercises and instruction on what to do until the next time.”