For many patients with minor spinal fractures, recovery is less about intervention and more about time. 

At the Royal Adelaide Hospital, the physiotherapy-led Spinal Virtual Clinic (SVC) is using technology, surveillance imaging and multidisciplinary care coordination to support patients recovering at home while maintaining clinical oversight.

The SVC, headed by lead physiotherapist Matthew Beard APAM, emerged in response to a problem increasingly familiar to clinicians across the country: an aging population living longer with frailty, multimorbidity and poor bone health. 

Low-energy vertebral fractures, often caused by relatively minor mechanisms such as falls, twisting, coughing or seemingly innocuous movements, are becoming more common as osteoporosis and reduced bone mineral density intersect with population aging.

While many of these fractures are painful, most are stable and heal conservatively over time.

Matthew says that prior to the introduction of the SVC, growing demand highlighted the need for a different model of care to better support patients and clinicians. 

Reviewing every patient face-to-face was becoming increasingly challenging and placed growing pressure on outpatient services; however, discharging patients back to primary care without specialist support could create a different set of problems.

‘We’ve gone down the middle. We support the GP by reviewing imaging at various time points to make sure that healing is
occurring and the deformity hasn’t progressed. 

'The GP can then communicate back to us and the team. 

'We’ve also utilised some proprietary software where patients can provide feedback on how they’re going.’

The public health implications of this approach are significant. 

Fractures account for most spinal injury-related hospitalisations and, for a health system already under pressure, repeatedly bringing older patients into tertiary settings for review is not always the most patient-centred or fiscally sustainable option. 

The virtual clinic’s model attempts to keep patients embedded in their local community, using remote monitoring, coordinated imaging and regular feedback loops to escalate care only when it is clinically indicated.

The SVC is not designed to replace specialist care, but rather to better target that care, says Matthew, who triages statewide spinal referrals. 

He describes a process of differentiating between patients with red flags requiring urgent intervention and those whose injuries are expected to follow a predictable healing trajectory.

‘Part of my role is to be able to separate out the ones who have neurological loss; the arms or legs aren’t working. 

'They’re a completely different cohort. 

'Then there’s a cohort who have a very unstable fracture… they need to be expedited for more urgent care that may or may not involve surgery. 

'But the great majority of patients we see now aren’t unstable; yes, they have a painful fracture but they will improve and the bones will knit together.’

In practice, this means that a patient referred to the SVC may remain under specialist oversight without ever physically entering the hospital. 

Imaging can be completed close to home and reviewed centrally, while nursing staff maintain communication with patients through the Personify Care platform to monitor symptoms, function and recovery. 

Where recovery deviates from expectations, clinicians can intervene earlier rather than waiting for a scheduled review appointment. 

This type of response surveillance is particularly relevant in older populations, where seemingly minor setbacks can quickly lead to a loss of independence.

For physiotherapists working in primary care, the model highlights a broader shift in thinking about fracture management. 

While the vertebral fracture itself may heal through conservative management, the secondary consequences of pain, immobility and reduced confidence can have profound implications for long-term health.

Older patients recovering from painful spinal injuries are at increased risk of sarcopaenia, reduced cardiovascular fitness, social isolation and falls, all of which contribute to declining function and increased healthcare utilisation.

Matthew says he is pragmatic about where in this picture physiotherapy adds the greatest value. 

He says there is limited evidence that passive modalities or electrotherapeutic interventions alter the healing trajectory of minor spinal fractures. 

Instead, he sees physiotherapists playing an important role in preventing the next injury and maintaining function during recovery.

‘You don’t want them [patients] to fall again. 

'There’s good contemporary evidence for the utility of falls and balance classes and things like that and that’s where physio as an intervention may have the strongest role.’

That prevention lens places physiotherapy squarely within the public health agenda. 

Falls prevention, strength and balance retraining, maintenance of mobility and addressing deconditioning are increasingly important as Australia’s population ages. 

For many patients, a vertebral fracture is not an isolated event but rather a marker of frailty, poor bone stock and reduced physiological reserve. 

Without intervention, a temporary injury can trigger a cascade of reduced movement, muscle loss and diminished independence.

‘Physiotherapy in primary health may have a role in those elements. 

'If you were talking globally about where physios might help a patient’s recovery, I think it’s addressing deconditioning and loss
of function, which inherently will happen if you’ve got a painful back that’s healing. 

'I think the most important thing they can do is stopping them from falling again.’

Equity of access is another defining feature of the virtual model. 

Matthew Beard.

Where geography dictates access to specialist care, rural and regional patients can experience fragmented pathways and long travel times for relatively brief consultations. 

For a person recovering from a painful spine fracture, travelling several hours to a metropolitan hospital for repeat imaging can be inconvenient, physically demanding and financially burdensome. 

‘When you realise how fragmented and sparse the medical care is – essentially, we’re providing a service that is identical whether you live in Wudinna or down the road in Thebarton. We’ve brought parity of care, which I think is important.’

For patients, the benefits are practical as well as clinical. Regional patients managed through the SVC avoid repeated trips to Adelaide for what might amount to a five-minute outpatient review. 

Imaging can be undertaken locally, with specialist teams reviewing results remotely and communicating with GPs about progression and next steps. 

The model also recognises that patients do not recover in neat timelines; a deterioration in pain or mobility can trigger escalation at the time rather than weeks later at a scheduled appointment.

Communication between specialist services and primary care is key, Matthew says. Rather than shifting responsibility onto GPs without support, the virtual clinic was designed for collaboration. 

Matthew describes GPs as ‘the centre of the spoke wheel’ in community care, with the virtual clinic providing specialist input, surveillance, imaging review and response escalation when required. 

‘We’re providing virtual support to the GP, remote monitoring of imaging and immediate surveillance from the patient’s point of view. 

'Then we have systems in place where we can identify people who are not progressing and can then escalate their care.’

For physiotherapists, especially those in community and regional practice, the approach reinforces the value of interdisciplinary care pathways that keep patients active and engaged during their recovery. 

Matthew says the instinct to ‘wrap patients in cottonwool’ after a spinal fracture is superseded by the need to maintain
mobility wherever possible, preserving function. 

‘Probably the worst thing we could do with a patient, if they were previously mobile, is wrap them in cottonwool. 

'We want to keep them moving and that may well be a role for physiotherapy in the community.’

Matthew says the clinic has expanded considerably over the past decade. 

What began as a small-scale idea has gradually developed into a statewide model supporting around 1000 patients a year, more than doubling in demand since the COVID-19 pandemic. 

Alongside this growth has come greater transparency and systematisation, with electronic referral tracking and documented triage decisions creating clearer accountability.

‘The whole journey of care is actually quite transparent. You can come in and look over my shoulder and say, “Where did that patient go and why did they go there?”’

The virtual clinic represents something broader about physiotherapy’s evolving role in contemporary healthcare. 

Matthew, who has worked in spinal care since the 1990s, now occupies a single triage and coordination role that may once have sat solely within medicine. 

His involvement in statewide referral management highlights the growing recognition of physiotherapists’ advanced clinical reasoning, diagnostic capabilities and ability to work at the top of their scope in complex musculoskeletal pathways. 

‘I think that’s a win for the profession – our decision-making is strong enough that the medical team is happy that I’m not making mistakes, because if I were making mistakes, I wouldn’t still be doing it.'

As Australia grapples with an aging population, workforce shortages and rising demand for specialist care, models such as the SVC offer a glimpse of how healthcare might continue to evolve. 

They also raise important questions for physiotherapists about prevention, care coordination and how best to support people to remain active and independent following injury.

For many older adults, a minor spinal fracture will heal with time. 

Preventing the next fall, maintaining function and ensuring equitable access to care, however, is likely to require something more deliberate: a healthcare system that, instead of always expecting patients to come to care, is willing to meet them where they are.