August 2015

Out on a limb: Hands-free therapy

1Limb-JordanaBy Jordana Bieze Foster, Editor

My former company launched a publication called Telehealth in 1998. Nearly two decades later, that magazine no longer exists, and telemedicine hasn’t revolutionized healthcare the way some thought it would. But advances are being made, and researchers are demonstrating that the potential applications for remote healthcare include disciplines that have always been considered “hands on.”

The publishing group that launched Telehealth had its roots in the world of radiology—a specialty for which working remotely makes all kinds of sense. With the right transmission and viewing equipment, most diagnostic images can be interpreted from anywhere in the world, and few patients are expecting to have face time with their radiologist. So, it’s not surprising that radiology remains a telemedicine trailblazer today, with some radiology practices now based entirely on remote image interpretations.

It’s not a huge leap from the remote assessment of radiographs, magnetic resonance images, and computed tomography scans to the remote assessment of diabetic wounds (see “Telemedicine: Bringing diabetic foot care to the small screen,” January 2015, page 14). Not only can telehealth technology minimize the need for patients with diabetic ulcers—who shouldn’t be ambulating more than necessary and definitely shouldn’t be driving—to make an in-person clinic visit just to check the status of a wound, clini­cians can provide informational and motivational consultations via cellphone, Skype, or other cyber-modalities.

Physical therapy and telemedicine, however, would seem to be mutually exclusive. Few clinicians have historically been more hands-on than physical therapists. How effective could a virtual physical therapist possibly be? Surprisingly effective, as it turns out.

In a recent Canadian study, two-month functional outcomes were similar for total knee replacement surgery patients who received either remote physical therapy or in-person therapy sessions (see “Telerehabilitation after TKA,” page 15). But the two experiences differed in significant ways. Unable to perform hands-on adjust­ments or manipulations on patients, the remote therapists had to be able to effectively explain how to do exercises correctly and how patients could perform basic versions of therapies like massage on themselves. The remote therapists also had to master the technical aspects of the video system, including panning, tilting, zooming, and using an on-screen goniometer.

It’s a somewhat different skill set than that required for conven­tional physical therapy. Not every clinician will excel at both versions of their job, and not every patient will respond equally
to both types of treatment. It will take a lot more research to determine which conditions and which patients are the best candidates for telerehabilitation. And then, of course, there are reimbursement issues to be hammered out.

But the possibilities are exciting. Not only does telerehabilitation have the potential to make therapy more accessible to patients, it also has the potential to make careers in physical therapy and rehabilitation medicine more accessible to individuals with disabilities who aren’t physically able to provide hands-on treatment.

Lower extremity clinicians won’t be as quick to embrace tele­medicine as radiologists have been, and for good reasons. But now that the telehealth trail has been blazed, smart practitioners will be thinking about where that path might ultimately lead them.

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