Will online (telehealth) consultations really work for me?
What is telehealth?
Online consultations (known as telehealth) are health services conducted via video streaming. With the changes due to COVID-19, more health care providers across the world are rapidly transitioning to telehealth for continuity of care whilst fully eliminating the risk to public health.
Can I get rebates for telehealth?
Legislation has been changing rapidly due to the current health crisis. Telehealth has been fast-tracked to be accepted for bulk-billed chronic management plans which have previously been issued by general practitioners. Various private health insurers (including BUPA) are also accepting telehealth rebates from the 14th of April (2020). Please contact your personal private health insurer to inquire as to whether telehealth is supported.
We have reduced our usual fee to $70 for telehealth consultations due to the current climate so that we can continue to care for you regularly and effectively.
What happens in a telehealth consultation?
This is probably the hardest part to get your head around before committing to trying telehealth as physiotherapy is normally so hands-on.
Think back to your previous face-to-face physiotherapy session...
We asked you questions
We watched your movements
We made you do exercises and/or gave you a push in the right direction
We spent 95% of the time talking with you
You left with homework and reassurance that you were on the track to recovery
The key thing to note is that we spend a lot of time talking with you and this is no different to a regular face-to-face consultation.
We may discuss your activity levels but also your work, the kids sports teams, if you cleaned your bathrooms on the weekend or whether you are driving out of town. We then draw attention to how modifying some of these activities can help you recover faster or even acknowledging that you might notice some discomfort after a 3 hour drive and that’s expected. We explain the principle of why you have these physical discomforts and how correct modification is actually the thing which makes you heal. We listen for the language you are using when you talk about how you feel about your condition, we talk about your fears and your personal goals. We reword explanations to calm these concerns and we do our best to convince you that there is a clear plan to your recovery.
How do you diagnose an injury without hands-on?
Physiotherapists are constantly using all the information accumulated from every single patient interaction we’ve had over the years and then calculating it against all the knowledge and skill we have developed (see Figure 1). This is a calculation cycle and is non-linear. We don’t decide it is one thing and then never revisit the possibility that it isn't. We constantly cycle back and check our work. That is called clinical reasoning.
Figure 1. A Venn Diagram of Clinical Reasoning.
There’s really good evidence to show that there’s a high level of consensus between telehealth and in-person diagnoses and decisions in chronic musculoskeletal conditions and ankle disorders (Ref 1-2).
But isn’t it better to have hands-on?
Have you ever wondered how a physiotherapist has to treat themselves? It’s often tricky to assess ourselves properly so we ask a colleague to check us out when they have a spare minute just to confirm our personal diagnosis. But ultimately what you will find is that physiotherapists rehabilitate ourselves with self-treatment. We do our damn exercises (often enough) and we avoid the aggravating factors (as best we can).
There are self-treatment methods which we often teach you but maybe you haven’t realised that it is exactly what we would do for ourselves!
These self-treatment methods are effective and can be done via telehealth and with the most basic home or office setups.
You can definitely feel better straight away from a telehealth session! It’s usually a combination of things which makes you feel better when you leave a face-to-face consultation. Understanding your condition and knowing there’s a clear plan is one thing. Knowing that someone truly cares and is leading you step-by-step is extremely key to your recovery.
Does it actually work?
The short answer is yes. It works. We can safely say that many physiotherapists have been doing telehealth unofficially even before graduation. Trust us. For years, we’ve been successfully consulting online for our family members, best friends overseas who don’t like visiting local health professionals and our acquaintances who message on WhatsApp saying “what do I do about this weird elbow pain that’s been going on for months?”.
There’s a reasonable level of evidence that telehealth has a positive impact on health outcomes in people with musculoskeletal conditions (Ref 3). There’s also research which shows that telehealth is highly effective for other conditions including stroke, post-operative and chronic heart failure (Ref 4-6).
It works because your experienced physiotherapist uses clinical reasoning to diagnose and formulate the next steps to take. We guide you on a more efficient, bio-mechanically friendly path, load your body with enough exercises, educate you and calm your fears just like how we would in person.
So call us if you have any questions or book in your telehealth session directly through the usual link. You don’t need to download anything for the consult. We’ll also be in touch regularly through the messaging chat in PhysiApp and via email to answer any questions. We're looking forward to seeing you online soon!
Cottrell MA et al (2018): Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to advance-practice physiotherapy screening clinic. Musculoskeletal Science and Practice 38:99-105.
Russell TA et al (2010): Telerehabilitation mediated physiotherapy assessment of ankle diorders. Physiotherapy Research International 15, 3.
Grona SL et al (2017): Use of videoconferencing for physical therapy in people with musculoskeletal conditions: A systematic review. Journal of Telemedicine and Telecare 24:341-355.
Sarfim FS et al (2018): Tele-rehabilitation after stroke: An updated systematic review of the literature. Journal of Stroke and Cerebrovascular Disease 27, 9:2306-2318.
van Egmond MA et al (2018) Effectiveness of physiotherapy with telerehabilitation in surgical patients: A systematic review and meta-analysis. Physiotherapy 104, 3:277-298.
Hwang R et al (2017) Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. Journal of Physiotherapy 63,2:101-107.