How has telerehabilitation helped physical medicine patients through the pandemic, and what role will it play moving forward?

Delayed recovery has always been a concern for the workers’ comp industry. However, when the pandemic hit last year prompting the cancelation of musculoskeletal surgeries as well as physical therapy treatment, interrupted rehabilitation became a very real threat for injured workers and employers alike.

Fortunately, offerings like MedRisk’s Platinum Grade Telerehabilitation program– launched over three years ago– had already begun to nudge telerehab into the mainstream for injured workers. What momentum did telerehab gain during the pandemic, and what benefits do patients stand to gain from this model as we adjust to a “new normal?”

Telerehab Pre- and Post-COVID-19

Even before the pandemic forced the temporary closure of many physical therapy clinics, getting to and from PT treatment was not always easy for injured workers. Patient location, commute time and level/nature of injury often posed a barrier to appointment compliance. Telerehab was seen as a way to overcome these barriers to care and serve as an alternative to on-site medical treatment.

Historically, state-to-state insurance coverage for telerehab has varied. But during the public health emergency, the Centers for Medicare & Medicaid Services and many states approved the use of telemedicine for physical medicine, at least temporarily – and patients have taken full advantage. MedRisk’s own telerehab numbers increased six-fold between January and April, and utilization has sustained above-average rates throughout the rest of the year.

A Different Goal & Approach

In this CompTalk presented virtually during the 2020 National Workers’ Compensation Conference, Brian Peers, DPT, MBA, MedRisk’s Vice President of Clinical Services and Provider Management describes how MedRisk quickly adapted to the access issue created by the coronavirus.

Before COVID-19, access to PT clinics wasn’t a big issue in the U.S. like it is in other countries that adopted telerehab earlier. Instead, convenience drove most of telerehab’s use. Patients in rural areas used it to avoid long distance commutes to a clinic. Some preferred telerehab to taking more time off work and spending it on the road. In the case of a traveling nurse practitioner who spent every night in a different town, telerehab was the reason she could keep working during her recovery.

When the pandemic created an access issue, MedRisk’s clinical team expanded its telerehab hours and criteria, which had been fairly conservative, to make sure patients had access to care. It turned out that more conditions than originally thought could be successfully treated via telerehab. Outcomes were good and patient satisfaction was high.

For example, Chris B. needed post-surgical PT after a quite involved rotator cuff surgery. Normally, he would start therapy in a clinic, but the clinic was forced to close the day he was supposed to start therapy. Delaying PT could have resulted in long-term mobility deficits and a decreased tolerance for lifting that would have prevented a return to full duty. Telerehab got him through the critical stage until clinics reopened and most of all he said, “I didn’t feel like I was totally out there on my own.”

Another patient needed to avoid clinics to protect her immune-compromised daughter, who was a cancer survivor. The patient could not shower alone, couldn’t stand for more than 5 minutes and had trouble getting out of bed after lumbar surgery following a major crush injury and needed immediate PT. Through telerehab, she progressed to standing during whole visits, lifting 10-15 pounds and being able to walk her dogs. When asked what she liked best about telerehab, she was quick to say, “I felt safe.”

MedRisk patients’ experiences align with the those captured in a recent patient satisfaction study published in The American Journal of Physical Medicine and Rehabilitation. Researchers surveyed patients and patient care advocates for pediatric patients who used telerehab during the pandemic.

Online surveys were completed after participating in a telerehab visit. Participants gave very good to excellent ratings for these areas:

• Addressing my concerns and questions
• Communication with my therapist
• Developing a treatment plan
• Execution of the treatment plan
• Convenience
• Overall visit satisfaction
• Value in having a future telehealth visit

Optional qualitative comments at the end of the surveys showed that respondents appreciated having access to the virtual services, which included physical therapy, occupational therapy and speech therapy.

Clinical Outcomes

For legislators, insurers, employers, and other stakeholders to be convinced of telerehab’s staying power, we need to also consider the clinical effectiveness of this model.

In the field of physical therapy, the utility and effectiveness of telemedicine has been analyzed in recent studies, and according to 2016 research, clinical outcomes associated with telehealth sessions may be equal to that of traditional in-person care services.

The Bini & Mahajan study compared the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient PT to those who participated in PT delivered through an asynchronous video-based tool. The 23 narrated videos created for the study demonstrated the same exercises taught in clinics, were each under 3 minutes in duration and featured on-screen text-based instructions.

On average, study patients engaged with the video-based model reported exercising for a mean of 47 minutes a day. They also logged in 49 times during the study period, posted 9 videos and 5 photographs, and sent 10 messages to their physical therapy providers. And, while patients utilizing the traditional care model logged 11 more minutes of exercise a day, they also reported a mean travel time to appointments of 75 minutes.

Patient satisfaction levels were high among both patient groups, with participants reporting that it was “easy or very easy” to communicate with their physical therapist. On top of this, the study authors write that “clinical outcomes following asynchronous telerehab administered over the web and through a hand-held device were not inferior to those achieved with traditional care,” suggesting that telehealth sessions of this nature are clinically equivalent to the in-person care model.

Conclusion

Telerehab has been proven to be a ready and viable solution during the COVID-19 crisis; however, it is important to remember that a public health emergency is not the only crisis injured workers can face in their recovery. Whether it’s an hour-long drive to the closest PT clinic, an injury that makes it difficult to drive or the weight of family responsibilities, virtual treatment will remain a valuable and cost-effective alternative for ensuring continuity of care for injured workers. For these reasons, industry experts are hopeful that telerehab is finally here to stay.