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About two weeks ago, Sonja Peneueta threw her back out moving a car seat. This isn’t her first rodeo with back problems, so she tried figuring it out on her own. But by the time she realized she needed expert help, COVID-19 had effectively blocked the door. At home with her three kids, her situation was not exactly an emergency, but it was far from ideal.
“I thought, gosh, now I have to live with it,” Peneueta says.
Until she realized, she didn’t have to: Sarah Ceschin, a Doctor of Physiotherapy in Boulder, Colorado, had just announced via Instagram (Peneueta was a follower) tele-health services for those who were finding it hard to get to a clinic. That was music to Peneueta’s ears, especially since she lives in Virginia.
“We’ve talked several times in the last couple days. I sent her a video of me doing exercises she recommended, and tell her exactly when it hurts and where,” Peneueta says. “I’ve had hands-on PT in the past, and there’s value in that certainly, but I feel this is actually a better experience. She’s really good at listening, and communicating—I feel like she has a better understanding of my back pain. And she’s more focused on me, she can take more time [than a clinic appointment] and we can tailor the sessions to my day, which is a little crazy because I’m trying to figure out how to homeschool my kids.”
A Chance to Learn
Another big plus of tele-PT for Peneueta is that she’s actually learning how to do stretches and strengthening at home, and can troubleshoot with Ceschin as issues come up, in situ. “I’m a fan of telemedicine, even aside from the virus situation,” she says. “I don’t know if I’ll go back [to traditional clinic visits].”
Ceschin concurs. “My biggest challenge [with telemedicine] is obviously not being able to be hands on, but this is a great time for people to learn how their bodies can be their own form of medicine,” she says. “By teaching exercises to strengthen hips or other muscles, we’re able to reduce pain and get patients back to activity without surgery or medicine. I started offering these services as a response to COVID-19, but I think it’s a great tool, and I’ll likely continue to use it after the quarantine.”
Kelly Kuhn has been a physical therapist in Pittsburgh for 18 years. About a year ago, she started moving to tele-health, and was 100 percent electronic about six months ago. The shift was not COVID-19-motivated, but driven instead by a desire to spend more one-on-one time with patients, more time educating patients, and providing more actual care for her patients’ dollars; something she felt was increasingly not possible in a brick-and-mortar clinic reimbursed by insurance.
More Time, More Attention, Less Money
“When you go to a clinic, there’s a limited amount of time for each appointment. The PT has to see three or four patients at a time—insurance can’t or won’t pay a therapist to see one patient for 1-½ hours. Most patients come two or three times a week for a month, two months. The copays add up,” Kuhn says. “With tele-health, I charge $95 for an initial evaluation that may take an hour-and-a-half. That’s one-one-one, looking at the whole picture—their injury history, mileage, current stressors, sleep, everything. My running patients send me a video of them running on a treadmill which I analyze before the evaluation. During the appointment we use a webcam to see how they’re moving, and we develop a program. If they need to follow up, they can text, email, or call at no extra charge.”
Runner Sarina Beasley is already a convert to tele-health—she uses tele-health extensively in her women’s health practice—but she got to experience it as a patient when she developed knee pain. She emailed Kuhn describing to her the issue, and Kuhn instructed Beasley to make a video of herself running on the treadmill, which Kuhn analyzed prior to their Zoom appointment.
“It was so convenient. She screen-shared with me during the appointment, showed me some asymmetries in my running, and demonstrated some exercises; a progression that would get me back to running,” Beasley says. “The appointment was about an hour-and-15-minutes, back in January. I followed that plan, and just today, ran 6 miles with no pain.”
Tele-PT services, Kuhn pointed out, have been used for a while in rural areas, by busy professionals, and by postpartum women with babies who find it hard to get to a clinic. She sees tele-health expanding in the future. Kuhn’s services are cash based, as are all the therapists I spoke with for this article, thereby circumventing not only insurance companies’ patient-mill model and their hit-or-miss coverage of tele-health.
“Therapists were looking for alternatives,” Kuhn says. “We need time to talk with patients, and educate them. People tend to be really happy with the [tele-health] experience. You don’t realize what you’re missing in health care—that one-on-one time—until you get it.”
As to tele-PT’s lack of actual touch, Kuhn says research shows manual therapy is temporary; movement affects improvement. “Most people need to know what to do and when to do it,” she says. “It’s empowering to the patient. If they’re educated about what to do, they can make their knee feel better without depending on the therapist. Changing strategies to empower patients decreases dependency on therapists. It’s more convenient, and efficient.”
When You Need Hands-On
Kyler Brown is a chiropractor with WellSport in Austin, Texas, a clinic that also offers PT and massage. Chiropractic medicine is, of course, defined by hands-on therapy. While he’s not ready to go 100 percent tele-health, Brown, like Kuhn, sees the advantage of being able to spend more one-on-one time with patients, educating them and structuring the rehab to their home environment, using whatever “equipment” the patient has at hand. While tele-health was always an option at WellSport, they’ve ramped up since COVID-19 restrictions were put in place, and now offer telemedicine sessions free for patients over 60 years old.
“Tele-health works best for continuing care,” Brown says. “Nothing replaces hands-on for assessing acute injury, or for that initial visit. I can’t palpate a muscle or test a ligament, and it’s sometimes tough to determine etiology of an injury [via tele-health]. Nothing replaces face-to-face.”
Brown gave an example of a runner who, while training for a marathon (that is no doubt now cancelled), pulled a calf muscle. The patient’s initial visit happened before the COVID-19 lockdown, but follow-ups have taken place via Doxy (a HIPAA compliant platform like Zoom for tele-health), with Brown observing the runner performing functional tests, listening to the patient’s description of pain, and demonstrating exercises.
More recent patients have had to be assessed remotely as well, and Brown has found that adequate for many. “I’ve had about 100 tele-health appointments this month,” Brown says. “I’m completely confident in the assessment of 90 of those cases. With the other ten patients, I recommended they go see someone face-to-face.”
The bottom line is that if you’re hurt, you don’t have to suffer through the COVID-19 crisis. With numerous tele-health options you can get expert help, plus learn more about your body and your treatment than you might if you went in person. Physical therapy may never be the same.