It feels like a distant memory now, when we were asked by Leo Varadkar to “come together as a nation by staying apart from each other”. This resulted in many people having to quickly change their working environment to try work from home but as a musculoskeletal physiotherapist, working in private practice, providing my patients with treatment and care suddenly seemed impossible. Physiotherapy by its nature involves close physical contact, however during the COVID-19 pandemic outbreak; conventional musculoskeletal physiotherapy treatment was just not feasible. This left many patients concerned, particularly those living with pain or disability. Many physios turned to telerehabilitation (telehealth/telemedicine) to help patients manage their health/pain and monitor their rehabilitation/progress. But, can you do physiotherapy over a video call? Simple answer is yes! In fact, before we ever heard of COVID-19, various studies demonstrated that telerehabilitation or online consultations were effective and comparable to standard practice for musculoskeletal/orthopaedic conditions or post-surgery1,2,3.
On an even more positive note, the majority of patients reported being “very satisfied” with telerehabilitation sessions4. While the ‘hands-on’ aspect of a conventional physiotherapy assessment/treatment session is missing during a telerehabilitation consultation, the majority of a physiotherapy assessment is valid and reliable when assessed in an online consultation5, 6. Your physiotherapist can assess your symptoms and design a management plan for you during an online consultation, which will involve expert advice and prescription of exercises, much as you would receive during a face-to-face appointment. In fact, many published guidelines on the management of non-specific low back pain highlight education, effective communication and advice as key interventions7,8. Some of the most effective physiotherapy skills are listening, educating and reassuring the patient.9 So ‘hands-on’ physio is not always necessary for best outcomes!
So, should we just abandon face-to-face physiotherapy altogether? Let’s not write-off the years and years of conventional physiotherapy just yet! Telerehabilitation definitely helped many physios and their patients manage pain/injuries during the lockdown and a lot of the physiotherapy assessment can be completed on a video call. However, not all parts of a physiotherapy assessment and treatment are as feasible in an online consultation, particularly assessments such as neurodynamic testing and some orthopaedic special tests.5 So now that the restrictions are easing and we’re returning to some kind of normality, patients can avail of more conventional physiotherapy appointments, albeit with a few changes. Facemasks, goggles/face shields and aprons are now a normal part of our work uniform and patients are expected to wear a facemask to the clinic also. Appointment times have been altered to allow for extra time between patients and close-contact time (within 2m) is limited. These are necessary changes to allow the physio to safely assess and treat you, during this time while restrictions are easing.
Switching from face-to-face physiotherapy appointments to telerehabilitation has probably been a challenge to many physios; however, it has also improved our communication skills and our clinical reasoning, as we can no longer rely on our ‘hands-on’ skills. It has caused us to be more creative in how we assess function/impairment and how we prescribe exercises. Physiotherapists have a wide-range of ‘hands-on’ and ‘hands-off’ skills, and not to underestimate or disregard the benefit of therapeutic touch, but following its forced absence we might appreciate our ‘hands-off’ skills a little more. Telerehabilitation has opened up many new possibilities, allowing physios to check in with patients based all over the country and improve our problem-solving skills! For now, we must all embrace these changes as normal life resumes and we get back on our feet after lockdown.
- Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 2017;31(5):625-638.
- Jiang S, Xiang J, Gao X, Guo K, Liu B. The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. J Telemed Telecare 2018;24(4):257-262.
- Shukla H, Nair SR, Thakker D. Role of telerehabilitation in patients following total knee arthroplasty: Evidence from a systematic literature review and meta-analysis. J Telemed Telecare. 2017;23(2):339-346.
- JM Polinski et al, Patients’ Satisfaction With and Preference for Telehealth Visits, J Gen Intern Med 2016;31 (3), 269-75.
- Mani S et al, Validity and Reliability of Internet-based Physiotherapy Assessment for Musculoskeletal Disorders: A Systematic Review, J Telemed Telecare 2017;23 (3), 379-391.
- Cottrell, M. A., et al. Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Musculoskel Sci Pract 2018;38, 99-105.
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. London: NICE, 2016
- Almeida M, Saragiotto B, Richards B, Maher C. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust 2018;208(6):272-275.
- O’Keeffe M, O’Sullivan PB, O’Sullivan K. Education can ‘change the world’: Can clinical education change the trajectory of individuals with back pain? BJSM 2019;53:1385-1386.
Caithriona Yeomans is a Senior Physiotherapist working in private practice and holds a MSc in Sports and Exercise Medicine (Queen Mary University of London). She recently completed PhD in the Department of Physical Education and Sports Sciences at the University of Limerick where she worked with the IRFU to implement injury monitoring and prevention programmes in rugby. Her areas of interest include rugby, dance medicine, paediatrics and exercise rehabilitation. Her teaching interests include sports injury and biomechanics. View Caithriona’s profile on LinkedIn , Researchgate or follow her on twitter @cyeomansPT Contact her at caithriona.yeomans@ul.ie.
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