Digital Practice (online healthcare)
Online physiotherapy service has been available for over 10 years. It’s been called different things; virtual care, telehealth, telerehab, telephysiotherapy, online rehab. These terms are somewhat interchangeable. More recently, the World Confederation of Physical Therapy (WCPT) has defined this as Digital Practice.
Digital practice is a term used to describe health care services, support, and information provided remotely via digital communication and devices. (WCPT/INPTRA Digital Practice Report, May 2019)
Purpose of digital practice
To facilitate effective delivery of physical therapy services by improving access to care and information and managing health care resources. (WCPT/INPTRA Digital Practice Report, May 2019)
How does it work?
Each session is conducted via video (webcam), where the physiotherapist connects “live” with the client at a predetermined day and time. Personal computer (PC), laptop, tablets or smartphone can all be used for video sessions. It can be done in the comfort of your home, at the office or while you’re away on a trip. Whenever you need help!
Privacy and security are of outmost importance so all participants should ensure a secure internet connection and a room where confidentiality can be guaranteed.
The physiotherapist conducts the interview component of the initial consultation (assessment) in the same manner he or she would start an in-person session; that is by asking a series of questions regarding the injury, medical history, pain levels, functional limitations and expected treatment goals.
The objective assessment (tests) may differ a bit from an in-person consultation since the physiotherapist cannot place their hands on the client and “feel” movements. However, much of the physical exam can be done by instructing the client to move in the front of the camera, while the physiotherapist observes the client move. Many household objects can be used as props during the assessment. What the client reports in terms of pain, weakness or mobility restriction, while executing the tests, will help the clinician determine what the nature of the physical injury is.
Is it “real” physiotherapy?
Of course. The Canadian Physiotherapy Association (CPA) defines physiotherapy as such: “Physiotherapy is anchored in movement sciences and aims to enhance or restore function of multiple body systems. The profession is committed to health, lifestyle and quality of life.” (Description of Physiotherapy in Canada, CPA 2012)
This means that physiotherapists are health professionals with deep understanding of human anatomy and how each body part moves and how they are all interconnected (muscles, joints, ligaments, muscles, and nerves). The goal of treatment remains the same as in-person sessions; to help a person regain normal mobility, restore normal function, and help improve one’s quality of life. Videoconferencing allows the physiotherapist to do just that.
What bout ultrasounds, hot/cold compresses, TENS unit, acupuncture?
These modalities are what we call “adjunct”. They may be helpful in the beginning for pain relief, but in the long term, their efficacy dwindles. The most important part of physiotherapy is proper education of the injury, best practice (course of treatment), posture and activity pacing recommendations for home/work, home pain management strategies, and progressive home exercise program. Again, digital practice offers that possibility.
Is digital practice for everyone?
Although most people can benefit from digital physiotherapy services, there are some clients that should refrain from using this type of service delivery. The following are examples of such:
- Presence of acute inflammation; redness, swelling, warmth and severe mobility restriction of a body part,
- Presence of neurological signs and symptoms, i.e. pins and needles or numbness in one/both leg or arm,
- Recent post-operative condition,
- A recent history of trauma,
- Signs of traumatic brain injury,
- Severe and unmanageable pain.