Physical Therapy
The COVID-19 pandemic marks the first-time physical therapists (PTs) have been able to use telemedicine in Pennsylvania. As of April 2020, PTs are temporarily able to use telemedicine for evaluations as well as return treatment sessions. This new platform for delivering PT services has proven to be beneficial but also challenging as PT evaluation and treatment is, by its nature, largely manual based.
A PT’s ability to evaluate a patient with HNC is severely limited with video telemedicine and impossible with audio-only telemedicine. For example, range of motion cannot be objectively measured, manual muscle testing cannot be completed, and pain and tissue restrictions cannot be assessed. These limitations make it challenging to create an optimal patient plan of care. As a result, we continue to encourage patients with severe limitations post-treatment to consider a one-time evaluation in our clinic for proper assessment and to teach crucial manual skills that can be completed at home. This one-time visit will assure better care long term and demonstrate safe, effective basic manual therapy skills; however, we are increasing their community exposure, so this decision cannot be made lightly. If patients are unable or unwilling to attend or do not have severe limitations, telemedicine evaluation is considered with a focus on estimating motion and tissue restrictions to formulate a plan of care.
Treatment sessions via telemedicine are being accomplished with a focus on reinforcement of home manual skills and a robust home exercise program. PTs are demonstrating self-myofascial release, manual lymph drainage, and trigger point release on themselves, and having patients or loved ones mirror the skill on the patient. Therapists must also be diligent in assessing a patient’s form with therapeutic exercise to assure patients are exhibiting proper movement patterns. Manual therapy handouts and home exercise programs are being mailed or emailed to the patients following the visit, and the patient is encouraged to follow up with the PT via phone or email in between the mandatory seven-day window between telemedicine visits.
Despite these pitfalls, telemedicine has proven to be a beneficial option of PT care delivery long term: outpatient physical therapists are now able to watch a patient function in their home environment and assess their ability to modify and complete self-management strategies. Via video or phone, PTs can continue to act as coaches to encourage patients to progress their functional mobility with their own means and equipment. Such a treatment model could serve two particular patient populations well: patients with cancer undergoing radiation or chemotherapy who may be too ill or fatigued to attend therapy in person and patients who live geographically far from a skilled PT provider.