Is there evidence that telehealth is an effective physiotherapy service delivery mode for any clinical conditions?

Yes, there is evidence that telehealth is effective in physiotherapy for some conditions, particularly osteoarthritis and other chronic joint pain conditions, in rehabilitation following joint replacement surgery and for patients requiring cardiac rehabilitation or pulmonary rehabilitation.

There is also less compelling evidence to support the effectiveness of telehealth for managing spinal pain, or post-spinal surgery.

However, research on the effectiveness of telehealth for other conditions and streams of physiotherapy is lacking.

Research has found that telehealth is well-suited to conditions where the focus of treatment is to provide education about, or advice for self-management of, a condition; prescription of therapeutic exercise; and follow-up and monitoring of progress.

Telehealth may be less suitable for conditions where hands-on treatment or manual therapy is required.

Why, then, do you think uptake of telehealth in physiotherapy had been slow prior to the pandemic?

The slow uptake of telehealth was likely due to a range of factors.

Before the pandemic, telehealth services in physiotherapy were not funded by private health insurers, which was a major barrier to implementation of these services.

Also, many physiotherapists lacked knowledge, experience and confidence in the delivery of care via telehealth, which is not traditionally covered in undergraduate training.

Patient and physiotherapist beliefs also played a role, with many remaining sceptical about the suitability of telehealth in physiotherapy practice, and holding a belief that in-person contact and hands-on treatments are necessary for care.

Finally, most of the evidence supporting telehealth has come from research settings, often as part of a clinical trial in highly controlled environments.

As such, it wasn’t clear whether this actually reflected the ‘real-world’ experience of telehealth in physiotherapy.

What methods did you use to gauge how the sudden expansion in telephysiotherapy was experienced by physiotherapists and patients?

We conducted two online cross-sectional surveys of 207 physiotherapists and 401 patients across Australia who had used telehealth (individual consultations and also group classes) during the pandemic in 2020.

Our customised surveys asked respondents about their experiences using telehealth services, including their perceived satisfaction and the effectiveness of the service.

Our physiotherapist survey also asked about experiences implementing telehealth, including costs, safety issues, facilitators and barriers.

What were the physiotherapists’ views?

We found that physiotherapists gave moderate to high ratings for the effectiveness of, and their satisfaction with, telehealth (average 7–8 out of 10).

Around two-thirds of physiotherapists found at least one of their patients was unsuitable for telehealth, most often because the patient was unable to access appropriate technology, had a complex problem or required hands-on treatment, or because the physiotherapist was unable to adequately assess the patient via telehealth.

Facilitators of the delivery of telehealth included having a good technology set-up, preparing ahead of appointments, having patient resources available and having patients who were willing and engaged.

Barriers to the delivery of telehealth included technology issues, the lack of physical touch, a perceived inability to assess the patient and inappropriate room set-up at either the patient or physiotherapist end.

A key safety issue for the provision of care via telehealth that was identified by physiotherapists was falls risk.

What about the patients?

We found that the majority of patients believed telehealth was the same or better quality than in-person care, though 41–43 per cent rated it as being lower quality.

More than 80 per cent of patients had positive perceptions about the ease of using the technology for telehealth, their comfort communicating via telehealth, their satisfaction with the management of their condition, the privacy or security of the consultation, their safety during the consultation and the effectiveness of telehealth.

The perceived advantages of telehealth included convenience, accessibility, reduced waiting time and undivided physiotherapist attention.

Were physiotherapists and patients interested in continuing telehealth consultations into the future and beyond the pandemic?

Yes, the majority of physiotherapists intended to continue offering telehealth beyond the pandemic, with 81 per cent intending to do so for individual consultations and 60 per cent for group classes.

Around half of the patients indicated that they were likely to choose to use telehealth for individual consultations beyond the pandemic, with 28 per cent not at all likely to do so.

For group classes, almost two-thirds indicated that they were likely to choose to use telehealth beyond the pandemic, with 13 per cent not at all likely to do so.

This suggests that videoconferencing is a viable option for the delivery of physiotherapy care in the future.

This work was supported by funding from the Physiotherapy Research Foundation.

>> Kim Bennell is an academic physiotherapist and Redmond Barry Distinguished Professor and NHMRC Investigator Fellow in the Department of Physiotherapy, University of Melbourne. She leads the multidisciplinary Centre for Health, Exercise and Sports Medicine.