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.