Are Virtual Visits for Physical Therapy worth it?

Francisco Quinones, DPT

.

There is no doubt that we are living in strange times. Many things we used to take for granted as “normal” will no longer be the norm moving forward. Based on what infectious disease experts are saying we will all have to figure out a way to live with COVID-19 for the foreseeable future and that means adjusting to a new normal. 

Virtual visits are not really new. Originally Virtual Visits were thought of as an answer to the difficulty of improving healthcare access to rural & underserved populations. Since the Coronavirus became a pandemic there has been a big push to increase the use of Virtual Visits for healthcare everywhere, as it maintains access for patients while eliminating risk of exposure for all parties. It looks to be the new normal, not just for PT but healthcare in general for the foreseeable future.

What can a PT offer in a Virtual Visit?
There is a false perception that the hallmark of our skill set lies in our ability to help people with our hands, what we call Manual Therapy. The reality is Manual Therapy is only a small part of the skills a physical therapist has at their disposal. On average a PT has between seven and nine years of college education with the last three years spent in intensive training to obtain a Doctorate of Physical Therapy (hence the DPT behind a PTs name). 
Unlike Doctors and Surgeons (or even Chiropractors) PTs do not usually have imaging at our disposal so we have been extensively trained in pattern recognition. We are trained to identify and categorize injuries based on clusters of signs (what we test) and symptoms (what you tell us you feel). We have extensive knowledge of the musculoskeletal system and Anatomy and Physiology. 
PTs know how the human body works. We know how particular joints are loaded based on the mechanics of a movement pattern. We know how to identify limitations in movement and where compensations are likely to occur as a response. We also have a thorough understanding of exercise and how to modify exercise to shift load away from painful tissues (joints, tendons, muscles, ligaments, ect) and toward tissue that is not compromised. We also know how and when to progress loads gradually back to those painful tissues to drive adaptation and get them back to doing what they were capable of doing pre-injury. 
That is all a long winded way of saying we have a lot to offer people beyond what we can do with our hands. 

What does a Virtual Visit look like?
What do I need to be ready?

1. A good internet connection. The biggest factor for having an efficient and effective appointment is simply having an unencumbered connection. That means closing/turning off anything that is taxing your WiFi during your appointment as this will slow down your connection and decrease your video and audio quality. Close all streaming music & videos and schedule your appointment when no one else in your household is in a virtual meeting. 
2. Be prepared to have to work out a few glitches. Whether it’s poor lighting, kids or pets interrupting, or altering a few settings on your computer, there are usually a couple of hurdles to overcome. This is normal and nothing to be worried about. 
3. It might be helpful to have someone in your house with you. If you are not technology savvy it would be a good idea to have someone around who is. We may be able to teach someone in your household how to perform a mobilization that helps your symptoms. We may also be able to use them to test your strength or set up an exercise. 

If you have already participated in a virtual meeting for work then it will look and feel very familiar to you. If you have not had the benefit of participating in a virtual meeting then just know it is not very hard to figure out and works surprisingly well. Also, the use of virtual visits is not likely to go away anytime soon so better to jump in now while we are all still learning. 

What if I don’t have any exercise equipment at home?
This is one of the real benefits of Virtual Visits, we get to work with you in your home environment and brainstorm with you how to overcome obstacles in your way to recovery. Really it comes down to creativity, and it is hard to imagine a scenario where we can’t figure out things in your household that will work just fine for the movements you need to perform. 

Will my insurance pay for it?
 The short answer is it may... and it may not. The long answer is things are changing daily. There is a lot of political pressure currently to make insurance companies pay for telehealth services. On 4/22/20 Governor Bullock announced that he was declaring a state of emergency to dictate insurance companies have to pay for it. If you are not sure if your insurance company covers Virtual Visits let us help you figure it out. 

Are Virtual Visits private & secure? 
Any platform Alpine uses has to be HIPPA compliant meaning yes they are private and secure. Security on the internet however all comes down to the weakest link in the chain. With that in mind it is a good idea to look into how secure your internet is at home. Some basic recommendations are to ensure that your wifi is password protected with a good strong password (google tips to secure wifi). To really ensure you have a secure connection anywhere you go, having a VPN is a good idea (do I need a VPN). 
Unfortunately our reliance on computers and home internet will only go up during this crisis so now is the time to make sure you are taking the steps to keep your internet as secure as possible .  

Why are PTs pushing for Virtual Visits? 
There is a big risk/reward calculation to be made about doing an in-clinic visit.   Currently, no matter how valuable an in-clinic visit may be it also comes with an increased risk of exposure for all parties. Keep in mind the average transmission rate for COVID-19 is 2.5 (so every person, on average infects 2-3 other people). Virtual Visits are the best way to keep our patients safe while keeping up their care during this pandemic.
Aside from eliminating risk, the main benefit of Virtual Visits is creating independence. By working with a patient in their home, using what you have available we are helping to create the best path towards self-efficacy (empowering you to take control of your own journey towards recovery). Of course it would be easier to teach you how to use the equipment we have available in our clinic, or the equipment available at a gym but, if we can figure out a plan for you with what you have at home, you are more likely to do it. 
The goal of any PT is to get the patient to become knowledgeable about their condition and learn how to recover from it. Research has shown the greatest predictor of a future injury is a prior injury, so it’s important we give you all of the tools you need to take ownership & agency of your recovery. We want to ensure you have the tools necessary to minimize the potential for recurrence, and manage recurrence if your symptoms do return. We want patients to be little versions of ourselves when it comes to taking care of their bodies. PT is not just about giving you exercises to get better, it’s about giving you the knowledge to take care of your body now and in the future, and Virtual Visits are a great platform for us to provide a patient with the education they need to get there.

What are other patients saying about it? 

• Online PT is surprisingly effective! Because PT is so hands-on, I was dubious about trying it. Online, my PT was able to assess range of motion and listen to my concerns. I was given a technique to simulate massage stretching done by the therapist. I can now stretch at home much more often as needed. Game-changer. Combined with exercise it’s made a HUGE difference in my range, strength, and comfort. “HIGHLY RECOMMEND.”  - Betsy W. 
• I save a ton of time. I’m actually a better patient and I think I am healing quicker because I’m able to meet more frequently. - Betsy W. 

How do I schedule an appointment with Alpine for Telehealth?
This is the easiest part. You have three options:

1. Call 406-541-2606
2. ​Visit Alpine’s website and click on “schedule an appointment”. 
3. Email us at info@alpineptmissoula.com with your name, address and phone number and we will get in touch with you. 

Keep in mind you can always try a 15 min consultation as an option too if you are not sure if PT or Virtual Visits are right for you.  

Additional Resources:
​Address Health Concerns with Telehealth.
Receiving Quality Care at Home.