Resident therapist Elena Soles dives into what we have learned so far in this relatively new, virtual method of care.

Our already increasingly virtual world has become even more so during COVID-19. Seemingly everyone, regardless of lifestyle or work, is spending more time (if not the majority of time) facing a computer for meetings, family time, and medical needs. To many, when the option is available to come in person to Physical Therapy, the idea of spending yet another hour in front of a screen sounds grossly unappealing.

With cases on the rise and time stretched thin with work demands, many are wondering if telehealth is appropriate for them. Stride Physio is committed to the safety and wellbeing of our clients, staff, and community, and takes every effort to make our clinic a safe place for your physical therapy journey. 

Sure enough, the majority of current studies comparing telehealth with conventional physical therapy demonstrates an overwhelming equivalence of the two methods. In a study conducted by Duke University in 2016, outcomes were equivalent, if not improved, to conventional methods in regards to pain and readmissions. Nevertheless, individual concerns may alter the need for virtual services.

The 4 Most Common Telehealth Concerns

And what the research has to say about it.

In-person is more effective.

Looking at the current research under the “just had surgery” tab, you’ll find that studies have shown just as many positive outcomes with in-person and virtual methods. In fact, many of our therapists have seen improved adherence to exercise and exceptional outcomes from clients who have never even been seen once at our clinic. In fact, performing these exercises at home is linked to improved autonomy and self-efficacy, which are important factors in your outcomes in physical therapy.

“I don’t like working out at home.” / I don’t have the space.”

To these folks we say, you may actually be a BETTER telehealth candidate than most! Telehealth provides an opportunity for you to allow a therapist to see what you’re working with at home, your space constraints, nosy cats, etc. and come up with suitable solutions to allow you to be successful in your home environment. It may be a long time before gyms can open again, and physical therapy is most effective when exercises can be done more days in a week than simply the time that you are in your appointment.

So let us help you make your home environment one that is conducive to performing your exercises, which will help you work towards your therapeutic goals in a faster, more meaningful way. Don’t have weights? We’ll help you find suitable alternatives from your living environment. Have a fire hydrant? Jug of orange juice? Calm pet who loves to be picked up? You might have more gym equipment than you even realize hanging around at your home. We strive to make your goals and program something that you can incorporate into your life to have wellness as both a short and long term solution.

physical therapy stride physio telehealth telemedicine covid
Photo credit: Jonathan Borba

“I’m not good with technology.”

Good news, many clinics are! We use user-friendly platforms to ensure technological prowess is not a hindrance to using our telehealth services. Our staff is trained to make sure you know what to expect your first appointment, and we offer options such as testing out the software prior to your first session with our administrative team to make sure you are good to go for your first appointment.

“That might work for others, but I need manual therapy.”

While manual therapy is an incredibly valuable tool, research and our clinical experience indicates that exercise plays arguably the most important role in positive patient outcomes.

1.   Some studies have found while manual therapy can relieve relieve short-term pain quickly, exercise can actually have a faster effect on decreasing disability secondary to pain. 

2.   In fact, current research suggests that an overreliance on this toolkit can actually lead to poor physical therapy outcomes. As manual therapy is often a passive modality, it can exacerbate existing neural pathways that lead to disability and pain. This same research similarly underscores the importance of education, and understanding the “why” of your symptoms, as one of the most powerful aspects of physical therapy.

3. Telehealth provides a rich opportunity to dive into the complex and multi-systems approach to addressing your pain.  At Stride, we value treating the whole individual, and helping you make the lifestyle and activity changes necessary to improve your long-term quality of life. While we believe strongly in manual therapy as an effective therapeutic strategy, it is merely one of many successful tools in our toolbox to help you achieve your physical therapy goals. In telehealth, we are also able to teach you, or someone you live with, self-mobilization strategies. This is a great way to learn valuable skillsets that you can take with you to all your future endeavors.

covid healthcare response stride physio

So what are some benefits?

In addition the overwhelming support from current research, we at Stride have also noted a few upsides:

Flexibility – This is one reason we know Telehealth is going to be a lasting resource. Many clients have found they actually prefer this new method of healthcare delivery due to time constraints. You could simply roll out of bed and see your therapist over your morning coffee. For many of our parents, the ability to avoid finding childcare during your appointment also allows us to improve access to healthcare. Moving to Eastern Washington? Spending a week away from Seattle? Needing to self-quarantine due to exposure or anticipated contact with a family member? We come to you!

Cost – Telehealth gives you more flexible scheduling, where you could opt for even a 30 minute appointment for simply a check in with your therapist.

Dogs – Are you afraid you might miss the opportunity to see the famous Stride Physio canine therapy team if you opt for a virtual session? The good news is sessions delivered from the therapists home often include a canine sighting, particularly with the pups enjoying their natural habitat. If your therapist is in the clinic on the day your telehealth session occurs, there are usually ample opportunities to see a roaming dog or two.

Independence – We have been surprised as a team to see how successful clients have been who have opted for telehealth. Anecdotally, we have seen increased adherence to home exercise programs and increased opportunities for dramatic and effective lifestyle changes. Why? There are many factors we suspect, but one of the most prominent hypotheses is transference. There are many benefits to “getting out of your space” and leaving the chaos of home for your physical therapy, but without application in your living environment where your challenges occur, there can be a disconnect between your time at the clinic and performance of tasks at home. We help you find the space you need, the tools you already have at home, to make your home a more healing space and one that encourages you to implement your program into your daily routine.

Transparency – With workstation ergonomics playing a larger role as more transition to a work from home environment, a telehealth visit can help your therapist assess your needs with the greatest transparency. Some of those nagging injuries can stem from fairly simple origins, and we have seen early success with this method of evaluation.

Safety – It is important to acknowledge the risks that are inherent as we leave our home. At Stride Physio, we implement every safety measure with the latest (and often evolving) research to keep you as safe as possible during your time at our clinic. That being said, risks are inherent. Telehealth offers a unique opportunity to take extra precaution while continuing, or beginning, your work with your therapist.

physical therapy stride physio telehealth telemedicine covid
Photo credit: Dhaya Bentaleb

The Broad View

COVID-19 is testing our cognitive load, stress capacity, resilience, and resources. It has, however, offered us the opportunity to develop and improve healthcare delivery and access to wellness through alternative methods. They say that necessity is the mother of invention, and we believe Telehealth is here to stay. Many co-morbidities associated with severe COVID-19 reactions are linked to exercise and wellness, so now more than ever we want to be available to help you remain active and improve your baseline health. Telehealth offers us the unique opportunity to increase access to services by removing some of the barriers that existed long before the pandemic, and have only increased in our new, complex lives.

If you have questions about services offered, concerns about whether your pain can be effectively treated via telehealth, or any other matter, our team is here to help.

 

By Elena Soles, DPT

Bibliography

Bettger JP, Green CI, Holmes DN, et al. Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty: VERITAS, a randomized controlled trial. J Bone Joint Surg Am. 2020;102(2):101–109.

Bernal-Utrera, C., Gonzalez-Gerez, J.J., Anarte-Lazo, E. et al. Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial. Trials 21, 682 (2020). https://doi.org/10.1186/s13063-020-04610-w

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

Kuether J, Moore A, Kapan J, et al. Telerehabilitation for total hip and knee arthroplasty patients: a pilot series with high patient satisfaction.

Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther. 2017;25(3):160-168. doi:10.1080/10669817.2017.1323699