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Virtual PT is here to stay

Updated: Aug 26, 2020



Telerehabilitation has the potential to transform how Physical Therapy is delivered. The growth in telemedicine and, by extension, telerehabilitation has been described as a bubble created by the COVID pandemic. However, I will demonstrate that the demand for telerehabilitation has been increasing before the pandemic and was projected to grow exponentially. The current public health emergency catalyzed the growth and is permanently transforming how Physical Therapy will be delivered in the future. First, I’d like to review the drivers in telerehabilitation adoption before the pandemic.

A rapidly aging population is driving demand for PTs and is expected to increase by 28% in the next ten years ¹. (Figure 1)

Figure 1


Yet access to PT remains well below average in some geographical areas. According to data from the Bureau of Labor Statistics, large parts of the country currently experience shortages in PTs¹. For example, large metropolitan areas in New York, California, Texas, and Illinois have below-average PT coverage¹. (Figure 2) The problem is even more pronounced in rural and remote areas. This severely impacts the ability of patients to receive the care they require.

Figure 2 Source: Bureau of Labor Statistics


One population most affected are individuals with chronic, disabling illnesses. In one study, over 50% of respondents with chronic, disabling illnesses were unable to obtain rehabilitation services². The inability to access necessary services impacts the individuals’ ability to participate in social life and increases comorbidities and healthcare costs³. Geographic location, cost, and appointment times have been identified as access barriers that impact the patients’ ability to obtain PT³.

Second, access to PT, especially early in the rehabilitation process, is shown to be effective and reduces opioid use ⁴. In one study, healthcare costs for individuals with lower back pain who received early PT were as much as $1,500 less than those who delayed care or did not get PT⁵. This is supported in a systematic review by Ojha, et al(2016) which demonstrated cost savings from PT for patients with various musculoskeletal(MSK) disorders to be as much as $27366. Thackeray, et al(2017) found that PT referral and participation were associated with decreased opioid use in patients with lower back pain4. This research suggests significant potential cost savings and decreased opioid use from improved access to PT.

Third, there is growing evidence demonstrating that telerehabilitation can be as efficacious as in-person PT in reducing readmissions, alleviating pain, and improving patient function. Researchers at the University of Alabama have demonstrated that telerehabilitation can reduce readmission rates from 18% to 6% in patients with pulmonary disease ⁷. The Mayo Clinic has been able to reduce readmission rates by 40% in patients with cardiac conditions using rehabilitation delivered virtually⁸. Cotrell, et al(2017) analyzed 13 studies comparing telerehabilitation to traditionally performed PT⁹. They found that PT provided virtually is comparable and, in some cases better than in-person PT in reducing pain and improving function in patients with MSK conditions. Remote monitoring and exercise prescription by a PT through a mobile health application was found to be better than exercise alone in improving activity in patients with Parkinson’s Disease¹⁰.

However, despite its potential, significant hurdles remain in the widespread adoption of telerehabilitation. Most notably, legal, technological and privacy barriers have been identified¹¹. Nonetheless, this is an area where COVID has provided the most significant amount of tailwinds. Federal and state authorities have adapted regulation to facilitate access to Physical Therapy and insurance companies are making reimbursement for virtual care long term and/or permanent ¹² ¹³.

Finally, while the growth in telemedicine has been described as a “tsunami” as the result of COVID, the pandemic simply expedited solid growth trajectories. McKinsey projects telemedicine to be a quarter-trillion sector with 76% of patients and 57% of providers interested in participating¹⁴. There is increasing evidence that supports telerehabilitation as a viable, efficacious, and cost-effective way to provide PT. While there are barriers that must be addressed to adopt this care delivery model into the mainstream it is is a promising new technology that can improve access to PT by increasing patient convenience, decreasing cost, and reducing geographical barriers.

References

  1. Occupational Employment and Wages, May 201729–1123 Physical Therapists. In: Statistics DoL, ed03/2018.

  2. Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilton SA. Access to healthcare services among people with chronic or disabling conditions: patterns and predictors. Arch Phys Med Rehabil. 2003;84(10):1417–1425.

  3. Hinman RS, Lawford BJ, Bennell KL. Harnessing technology to deliver care by physical therapists for people with persistent joint pain: Telephone and video‐conferencing service models. Journal of Applied Biobehavioral Research. 2019.

  4. Thackeray A, Hess R, Dorius J, Brodke D, Fritz J. Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain. J Am Board Fam Med. 2017;30(6):784–794.

  5. Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15:150.

  6. Ojha HA, Wyrsta NJ, Davenport TE, Egan WE, Gellhorn AC. Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. J Orthop Sports Phys Ther. 2016;46(2):56–70

  7. Bhatt SP, Patel SB, Anderson EM, Baugh D, Givens T, Schumann C,Dransfield MT. Video Telehealth Pulmonary Rehabilitation Intervention In COPD Reduces 30-day Readmissions. American journal of respiratory and critical care medicine,2019;4 (ja).

  8. Widmer RJ, Allison,TG, Lerman,LO, Lerman,A (2015). Digital health intervention as an adjunct to cardiac rehabilitation reduces cardiovascular risk factors and rehospitalizations. Journal of cardiovascular translational research, 8(5), 283–292.

  9. 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.

  10. Ellis TD, Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study. Physical Therapy. 2019;99(2):203–216.

  11. Hinman RS, Lawford BJ, Bennell KL. Harnessing technology to deliver care by physical therapists for people with persistent joint pain: Telephone and video‐conferencing service models. Journal of Applied Biobehavioral Research. 2019.

  12. https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf. Accessed August 25, 2020

  13. Physical Health, Occupational and Speech Therapy. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-pt-ot-st.html. Accessed August 25, 2020.

  14. Bestsennyy O, Gilbert G, Harris A, Rost J. Telehealth: A quarter-trillion- dollar post-COVID-19 reality? https://www.mckinsey.com. Published May 28, 2020. Accessed August 25, 2020.

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