The Role of Virtual Physical Therapy in a Post-Pandemic World: Pearls, Pitfalls, Challenges, and Adaptations.

Abstract

To keep patients healthy and safe during the pandemic, payers and the federal government temporarily relaxed restrictions, expanded the eligible provider list for providing telehealth services, and developed a reimbursement structure. Physical therapists were uniquely challenged during the pandemic, requiring a reassessment of techniques and strategies in order to best support patients. The purpose of this case report is to describe a musculoskeletal institution's experience with implementing telehealth physical therapy. Previous telehealth experience enabled the infrastructure of a wide-scale adoption across institutions to respond to the COVID-19 pandemic. However, to fill in training gaps for Hospital for Special Surgery (HSS) outpatient physical therapists, HSS Rehabilitation developed a robust education and implementation program. This training was influenced by clinician and patient surveys as well as the development of a published HSS Rehabilitation telehealth guide. Prior to performing telehealth physical therapist visits, clinicians were required to complete all training material to ensure comfortability and confidence. The adoption of telehealth among clinicians was born out of necessaity; however, the speed with which HSS Rehabilitation pivoted was critical to avoid lapses in care. In a 4-week period after the New York City shelter in-place orders, 173 therapists were trained and performing virtual visits. HSS Rehabilitation determined telehealth physical therapy had quicker access to care, similar patient satisifaction, and increased geographical outreach compared with in-person care. The transition to telehealth physical therapy included a multi-step process that provided clinician training, established protocols and guidelines, and obtained a better understanding of the patient experience. Telehealth physical therapy has shown early benefits such as improving patient access to care and better continuity of care for traveling patients. Even after the current public health emergency, there is a place for high-value telehealth physical therapy in caring for patients with musculoskeletal conditions.