The physical therapy profession now has the first-ever telerehabilitation clinical practice guideline specifically for PTs and PTAs — "Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association.” It's a timely resource and a big step forward.
In developing the guideline, authors reviewed articles published between 2010 and 2022, leading to seven recommendations related to the various facets of telerehabilitation. (Look for additional supporting materials on the CPG in the coming weeks, including an APTA CPG+ resource, pocket guides, a podcast with lead authors, and more.)
While the cutoff mark for the CPG research review was in 2022, studies published in 2023 and 2024 continue to support many of the resource's fundamental aspects. Here are five recent articles on telehealth from PTJ: Physical Therapy & Rehabilitation Journal, Archives of Physical Medicine and Rehabilitation, and The Lancet that illuminate the benefits and feasibility of telerehabilitation.
Assessing the Feasibility of Telehealth Rehab After Lumbar Spine Surgery
In this randomized control trial, researchers sought to determine the feasibility and acceptability of telehealth and wearable device intervention after lumbar spine surgery. One set of eight patients underwent a physical activity intervention, which included eight weekly telehealth sessions with a PT, a wearable activity tracker, and a daily step goal. The second set of patients received usual care, as determined by the surgeon, including post-op lifting restrictions and pain medicine as needed. “A physical activity intervention incorporating wearable technology and telehealth counseling from a physical therapist appears to be feasible and acceptable for patients recovering from lumbar spine surgery,” authors found. This echoes the CPG recommendation that telerehab or hybrid care are at least equivalent to in-person services for patient acceptability and satisfaction for certain conditions. ("Combining Wearable Technology and Telehealth Counseling for Rehabilitation After Lumbar Spine Surgery: Feasibility and Acceptability of a Physical Activity Intervention," PTJ: Physical Therapy & Rehabilitation Journal; all PTJ content available for free to APTA members)
Gauging Variability and Use of a Hybrid Care Model for Low Back Pain
Focusing on hybrid care, researchers analyzed data from 701 veterans who were participating in the Improving Veteran Access to Integrated Management of Low Back Pain, or AIM-Back, trial. Sixty percent of veterans who were referred to the trial enrolled in the program, with 81% of the enrolled veterans participating in at least one telehealth physical activity call, with a mean of 2.8 calls per veteran out of a maximum six. Three-quarters of veterans who were determined to be at medium or high risk of persistent disability completed at least one call dedicated to psychologically informed practice, with a mean of 2.5 calls per veteran out of a maximum six. While researchers noted consistent delivery in core components of care including pain modulation and use of physical activity training, use of psychologically informed practice, number of telehealth calls, and amount of referrals were more variable. ("If You Build It, Will They Come? Patient and Provider Use of a Novel Hybrid Telehealth Care Pathway for Low Back Pain," PTJ: Physical Therapy & Rehabilitation Journal; all PTJ content available for free to APTA members)
The Role of Psychosocial Factors in Telerehabilitation
As part of an ongoing trial that was adapted due to the COVID-19 pandemic, 98 patients received eight PT sessions delivered via telehealth for low back pain. Among the participants, 16.3% experienced substantial clinical benefit. Authors write, “those experiencing substantial clinical benefit reported lower pain intensity, higher pain self-efficacy, and higher therapeutic alliance with their physical therapist compared to other patients.” In line with the CPG’s recommendations that PTs should work with patients to reduce barriers and promote facilitators to telehealth services, authors say the results of this study could be used to help screen patients who are more likely to respond to telerehab. "Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain," PTJ: Physical Therapy & Rehabilitation Journal; all PTJ content available for free to APTA members)
Older Adults and Telehealth Readiness
This study sought to measure video-based telerehabilitation readiness among older adults, a population that can face barriers to accessing these services due to higher rates of visual, auditory, or cognitive impairments. Using a nationally representative sample from the National Health and Aging Trends Study, authors sampled 5,274 older rehabilitation users, 64% of whom were seeking care for a musculoskeletal concern. About two-thirds of participants were telerehab ready, but patients living in rural areas or who had strained finances had lower rates of readiness. About 60% of white participants were considered telerehab ready, compared with 49% of Hispanic participants, 39% of Black participants, and 34% of those who identified as Asian, Pacific Islander, Native American, or multiple races. “While much of the focus related to the delivery of telerehabilitation more broadly has been related to broadband internet access, the main driver of telerehabilitation unreadiness in our data was a lack of technology ownership and/or proficiency with use.” APTA Public Policy and Advocacy Committee member Jason Falvey, PT, DPT, PhD, is lead author of this study. ("Demystifying the Digital Divide: Disparities in Telerehabilitation Readiness Among Older Adults in the United States," Archives of Physical Medicine and Rehabilitation; abstract only available for free)
Non-Inferiority of Telerehab for Knee Pain
Trevor Russell, PT, PhD, one of the co-leaders of the CPG development group, was one the authors of this study, which sought to compare telehealth and in-person PT care for knee pain from osteoarthritis. This study had 204 in-person and 190 telerehabilitation patients who were surveyed at baseline, and then at three and nine months afterward. Both groups saw improved outcomes at three months, with no meaningful difference in change in the primary measures of pain or physical function between the groups. Additionally, “cost-effectiveness analysis including private time and travel showed video conferencing offered net social benefits due to cost savings at 9 months,” authors write. As recommended in the CPG, PTs should discuss whether telerehab is a cost-effective options with their patients. ("Telerehabilitation Consultations With a Physiotherapist for Chronic Knee Pain Versus In-Person Consultations in Australia: the PEAK Non-Inferiority Randomised Controlled Trial," The Lancet; abstract only available for free)
