We spend huge chunks of our lives consuming digital content. And it’s no wonder, really. It seems like everything has gone digital. Shopping, banking, working out, hanging out. There is a digital option for almost everything. The global pandemic has continued adding to our already digitally saturated lives with US adults spending an average of 7 hours, 50 minutes (7:50) per day with digital content in the last year. The amount of time that we are spending with digital content has increased by 15.0% from 2019 and that growth will mostly be retained in 2021. Projections for social media use estimates the average adult will spend 6 years and 8 months of their life on social media. That's a LOT of time in the digital world.
The Rise Of Telehealth
It should come as no surprise then that healthcare has followed suit. In October 2020 the CDC published a report on the trends of telehealth usage during the Covid-19 pandemic. The report compared trends in telehealth encounters during January–March 2020 (surveillance weeks 1–13) with encounters occurring during the same weeks in 2019. They found that during the first quarter of 2020, the number of telehealth visits increased by 50% compared with the same time period in 2019. In week 13 they found a 514% increase compared with that same period during 2019. Across the board, everyone from large health systems to independent practitioners was making the shift to telehealth in order to manage care during the pandemic, and physical therapy was no exception.
History of Telehealth
Telehealth isn’t a completely new concept that arose from the pandemic. It has actually been around for quite some time. Probably one of the earliest and most famous uses of hospital-based telemedicine was actually in the late 1950s and early 1960s when a closed-circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital for psychiatric consultations. Behavioral health hospitals and providers have been using telehealth for quite some time now in order to address the growing shortage of psychiatrists in the US, and to help provide services for service users who live in rural areas.
Why Do We Need Telehealth
It’s no secret that the US is facing a shortage of healthcare practitioners across various specialties and the physical therapy field is among those most impacted. According to the Alliance for Physical Therapy Quality and Innovation, it is estimated that there will be an additional 27,000 physical therapists needed by 2025, with rural areas being the most affected. This is where telehealth can really make a positive impact.
So why haven’t we used telehealth much before now? How come everyone doesn't offer these services? Well, the answer really lies in reimbursement. Telehealth sessions have typically been reimbursed at an amount that was much lower than a traditional, in person, face-to-face visit. It wasn’t until the Covid-19 pandemic that CMS started to re-consider the rates they would pay for telehealth visits.
During the Covid-19 pandemic, patient visits to doctors plummeted, with healthcare providers reporting drop offs at almost 75%. Insurers quickly realized that telehealth services would be the only way that doctors would be able to manage their patients’ ongoing care with lockdowns and social distancing measures in place. As soon as it was announced that telehealth visits would be reimbursed at rates equal to in-person visits, doctors dove into getting their telehealth platforms up and running.
Will Telehealth Continue To Be Used Post-Pandemic?
With the rise of digital technology and healthcare wearables, Forbes magazine believes that “in 2021 we’ll see telehealth continue to play a huge role for patients” especially with issues like hypertension, diabetes and heart disease. Being able to track healthcare outcomes via wearable medical devices, and then being able to send that data to the service user’s healthcare provider to access virtual continuous care, will become more and more effective for long term management of chronic conditions.
And these days, wearables are so much more than the original versions of tracking devices like Garmin or Fitbit. From heart monitors and electrocardiogram applications, to temperature and reproductive cycle trackers, wearables are taking virtual healthcare by storm, helping healthcare service users self manage illnesses and chronic conditions.
Platforms such as Teladoc, Zocdoc, Betterhelp, and Mend are all examples of telehealth platforms that are being used, increasingly, to assist with scheduling doctor's visits, managing behavioral health conditions and providing virtual therapy sessions to clients.
So What is Digital Physical Therapy?
The Physical Therapy industry has been carefully considering the digital technology that is available for their patients for some time now. On March 18, 2020, a white paper on Digital Physical Therapy was approved by the World Confederation For Physical Therapy. The white paper was the result of thousands of interviews of physical therapists from around the world, seeing what role technology played in the treatment of their patients.
The task force described the advantages and limitations, regulatory issues, and recommendations for opportunities for using digital technology in physical therapy. They also proposed a definition for digital physical therapy as there is currently no one agreed upon explanation for this term. The task force proposed the following definition and purpose statements:
• Definition: Digital practice is a term used to describe health care services, support, and information provided remotely via digital communication and devices.
• Purpose: The purpose of digital physical therapy practice is to facilitate effective delivery of physical therapy services by improving access to care and information and managing health care resources.
So What Exactly Is Involved With Digital Physical Therapy?
In the world of physical therapy, the digital part of the definition can be quite broad. It can include things such as:
home exercise videos
virtual reality sessions for balance exercises
electronic health records
video assessments, and more.
Within this arena, companies such as Kaia Health, Reflexion, and Hinge Health, have developed products that help individuals, who have certain employer based healthcare plans, with their rehabilitation after musculo-skeletal surgeries. They have had great success with their programs and have helped to reduce the costs typically incurred by health insurance companies with these types of rehabilitation programs.
As technology advances there are sure to be new devices and programs coming to market that will assist with the rehabilitation of patients in both clinic and home settings.
Advantages and Challenges with Digital PT
So why isn’t everyone using digital physical therapy? How come my physical therapist uses one thing and someone else's PT uses something different? If digital physical therapy is so great, why doesn’t everyone know all of the products? Are these products even regulated?
With advances in technology occurring every day, it is almost impossible for physical therapists to keep up with everything that comes to market. Furthermore, not every product is available in every country. When it comes to the needs of the service users, depending on the country that you live in, your needs, and what is available, can be quite different from other people in other countries. Malta, for example, has a good ration of therapists to clients and they have a small geographical area, so digital visits are not quite as necessary as a country like New Zealand, which has a much larger area to cover and many people living far away from urban areas where therapists are likely to be located.
After speaking with physical therapists from around the globe, the working group was able to see some of the more universal advantages and disadvantages that technology could bring to PT. These are some of their key findings:
Key Advantages Of Digital Physical Therapy:
Expands the ability to connect with a physical therapist, regardless of distance or transportation.
Reduced barriers to treatment such as parking, waiting rooms and travel time/costs
Promotes independence for service users in managing their own condition - increased buy in from patients.
Improves flexibility of appointments for service users - less issues in taking time off work or arranging childcare.
Decreases costs associated with travel, childcare, lost work time, assistance with getting to appointments.
Easier to access services, service users don't have to wait as long to get an appointment.
Challenges of Digital Physical Therapy
When it came to the disadvantages, or probably more accurately, the limitations, this is what they found might be a challenge to using digital technology in physical therapy:
Internet connectivity is not always guaranteed, available, or stable
Patients are not always confident or able to use the technology. Training might be required, especially for older patients
Bandwidth can be an issue for quality of connections, especially video conferencing
Reimbursement is not always available, depending on the country that you are in.
So, as you can see, although telehealth is a wonderful tool with many benefits, and although it is generally well-accepted by both patients and clinicians, it does not come without its own challenges. Virtual visits are not always appropriate, depending on what type of treatment is required to provide the best standard of care. Services like diagnostic testing or ultrasounds obviously cannot be done virtually, but things like emergency rooms visits have been shown to be reduced by using telehealth services. What most healthcare professionals agreed on was that digital physical therapy is an excellent addition to their in-person services, or a useful tool to get to know service users better in their home environment. Physical therapists also found it to be helpful in speeding up access to appointments.
The Covid-19 pandemic has helped to usher in more widespread adoption of telehealth services, especially with its new reimbursement policies. But, whether those reimbursement options remain once the pandemic subsides is yet to be seen. What we do know is that, going forward, it is likely that some sort of hybrid model will emerge. This model would support in-person visits being supplemented with digital technology in order to provide timely, accessible, and cost effective treatments for physical therapy patients. Digital physical therapy will certainly continue to serve as a key modality for patient care even after the pandemic is done.