Jill Carnahan, PT, DPT, reflects on how her experience supervising MedRisk’s telerehab team has transformed her perspective on the role of virtual PT visits in injured worker recovery.

When Jill Carnahan, PT, DPT, began working on telerehab cases at MedRisk, she was skeptical. She had previously worked in outpatient orthopedics and women’s health, where therapy was strictly hand-on.

“That’s what’s ingrained in us as therapists – that patients have to be touched to get better,” Carnahan said.

But Carnahan, who now supervises MedRisk’s telerehab staff, kept an open mind as MedRisk launched its telerehab program in June 2017.

As the first managed physical medicine company to offer telerehabilitation for injured workers, the MedRisk clinical staff set out to blaze a new trail in the workers’ compensation industry. Before kicking off the program, they developed proprietary guidelines around how to identify the ideal telerehab patient. Carnahan recognized the company’s concerted effort to screen patients carefully and thoroughly examine the circumstances of each case. The guidelines stipulate that first a patient’s case must be found clinically appropriate for telerehab. Second, the patient must express an interest in participating in the program and have the technology needed.

Once a patient qualifies for telerehab and it is determined when telerehab should begin, Carnahan’s team reaches out to schedule the televisit. These virtual visits are synchronous – meaning patients and providers interact “face-to-face” via webcam. Through the live audio-visual interface, the PT is able to demonstrate appropriate exercises and monitor the patient’s movement on screen. The televisit is also an opportunity for the patient to speak one-on-one with their PT about any roadblocks to recovery and how to overcome them. Following the appointment, stored videos and printable written instructions are available to support patient compliance with their prescribed exercise program.

Convenience, Collaboration & Independence

When asked how her perspective of telerehab has changed since the program launched two years ago, Carnahan says that while she still believes that for many patients, manual therapy will always be an integral component of recovery, she has also seen that telerehab offers substantial benefits to the patient that cannot be replicated in an in-clinic visit.

Naturally, viritual visits are a convenient option for all patients, but for some, they are essential to keeping their treatment plan on track. Patients in rural settings often have to travel a significant distance for an on-site visit. In addition, for those in urban areas who rely on the subway or other public transportation, traveling can become even more complicated when recovering from an injury. Weather and natural disasters can also be complicating factors. MedRisk’s telerehab staff has even extended their hours following natural disasters, such as Hurricane Florence, to ensure workers’ recovery could stay on track. In these instances, travel can be a significant hurdle – one that is mounted through telerehab.

In addition, telerehab allows injured workers with regular on-the-job travel to remain engaged in their recovery as they get back to work. MedRisk’s team of telerehab specialists are licensed in many states, so treatment can continue even as patients cross state lines.

“We’ve seen lots of patients while they are out in the field,” Carnahan said. “Utility workers have logged into their visit from an outdoor location. Truck drivers have called us from the cab (berth) of their trucks. We make it work!”

There is no doubt that mobility and ease of use are attractive features for the telerehab option, but those aren’t the only benefits. According to Carnahan, her transformation from skeptic to telerehab champion is the result of seeing first-hand how powerful these virtual interactions can be.

“The more patients I’ve treated, the more I’ve realized that there is the power of touch and then there is the power of voice,” Carnahan said. “In the clinic, you manually move patients into positions. Sometimes there are distractions. Through the computer, you have to use your words – it’s a back-and-forth process that requires focus, communication and collaboration from both parties. But when the patient gets it on their own, you know they really get it.”

It’s this guidance, Carnahan says, that helps cultivate a spirit of independence and accountability in telerehab patients. For example, Carnahan’s team has sent equipment to patients with cervical injuries so they can be taught via virtual visit to do neck massages themselves at home. Others are shown how to do self-tissue releases and self-joint mobilizations so they can take more ownership of their recovery as they prepare for discharge.

What’s Next

As the MedRisk telerehab program gains traction, Carnhan’s team is growing. The company now offers onsite PTs trained in telerehab to larger employers who want a dedicated therapist available to support their primary and satellite offices. In the months and years ahead, Carnahan expects that, like herself, physical medicine professionals, patients and employers alike will realize the benefits of the program.

“Patients often say to me, ‘Why didn’t I do this sooner?’ I think we are going to be hearing that a lot moving forward,” Carnahan said.