Why Choose Telerehabilitation?

Danny Dinh

Physiotherapist

August 11, 2022

What is telerehab?

Telerehabilitation, or telerehab for short, is the delivery of rehabilitation services over the internet through programs such as Zoom and Google Meet. 

A physical therapy evaluation given through telerehab is structured exactly the same as an in-person visit: an interview about what is bothering you and what your goals are, a biomechanical assessment to look at how your affected joints or body parts are moving, and then an intervention where we combine therapeutic education and exercise prescription to help you reach your goals. For more details on those three components of evaluations and how I treat my patients, click here: link. 

For a detailed case study of how I helped my patient overcome her chronic low back pain through telerehab, click here: link.

Who is this for?

Telerehab is for:

• Anyone with musculoskeletal pain, whether due to an injury or insidious (came on its own). This means any muscle cramps or stiffness, back pain, neck pain, shoulder pain, and more.

• Anyone with persistent headaches.

• Anyone recovering from an operation.

The advantages of telerehab

1. Convenience: Doing your physical therapy consult from the comfort of your home means not having to commute to the clinic, resulting in saved time and money. This is especially advantageous if you live in a region without many physical therapy clinics. Telerehab increases your available options exponentially while helping you save on travel fees.
2. Telerehab allows me, your physical therapist, to meet you in your most natural environment: your home. In the clinic, my patients and I work together to create their rehab plan. This includes exercises for them to do at home to pursue their rehab even when our session is over. These exercises are often easy to replicate, but patients sometimes come across unforeseen issues that prevent them from doing those exercises: their kitchen counter being way lower than the counter used in the clinic, their dumbbells not going as high as the one in the clinic gym, etc. Performing these exercises in your home through telerehab allows us to absolutely confirm whether they are possible to do or not and if they are not, how we can modify or replace the problematic exercises to ensure you can start your rehab ASAP.
3. Many things are easier to evaluate in telerehab than in a clinic. Let’s think about it: where do you spend most of your time? Your home, of course. And for many people, the home is where they experience the most pain (not because it’s bad to be home, but because they spend the majority of their day there!). You have back pain when doing your laundry? Great, please bring your phone or laptop downstairs and show me how you do your laundry. Your right shoulder feels jammed when you try to reach for the highest cupboard? Alright, let’s go to your kitchen. I’ll be able to see exactly how you reach up and how high your highest cupboard is.
4. Safety: As a healthcare professional, your safety is always on my mind. For some patients, either due to other health conditions or due to an acute injury, leaving their home or driving for an extended period of time to reach my clinic may not be safe in short term. A patient I recently saw wanted help to recover her legs’ mobility and strength so that she could enjoy walks around her neighborhood. If she could not walk outside safely due to a fear of falling, how could I expect her to come to my clinic? Telerehab was our solution to this “catch-22” situation. It allowed us to create a rehab program to help her and, once she had achieved her goals of being strong enough to walk safely, we decided to continue our sessions via telerehab since there was nothing we wanted to do that couldn’t be done in the comfort of her home. Beyond physical safety, telerehab also eliminates the risk of catching a disease such as COVID-19. Thankfully, with the advent of vaccines and the hard work of public healthcare workers, this risk is lower than it once was, but telerehab remains a real option for patients desiring to remain safe from COVID-19.
5. Same as an in-clinic physical therapy session, telerehab sessions are covered by most insurance companies.

Why I personally enjoy telerehab

Beyond the very obvious reason of being able to work from home (have you seen these gas prices?), I love helping my patients through telerehab because it forces me to hone my communication skills to their maximum. A physical therapist mentor of mine once told me that many physical therapists fall into the trap of spending obscene amounts of money on courses to learn specific manual therapy techniques and neglect to nurture their most important skill: their ability to listen.

Although taking continuing education courses to improve one’s clinical reasoning and techniques is important, the vast majority of my patients do not come to see me for that: they come to be listened to and to understand what they should do about their pain.

Performing physical therapy through telerehab allows me to fully focus on the 2 principles that guide my practice: optimizing my patients' time frame of recovery and empowering my patients to be independent in their rehab. 

But what about palpation? How can you know what is wrong with me without feeling it with your hands?

Palpation is when the therapist puts their hands on your painful body part to feel for any anomalies, such as swelling, deformation, or muscular atrophy. Palpation is something I sometimes do in my in-person assessments, especially in newer injuries, but it is only a small part of the assessment. 

Joint movement, muscle strength testing, and function testing (which is looking at functional movements such as squatting, walking, or lifting) make up most, if not sometimes all, of the biomechanical assessment and can be done through telerehab with no limitation.

Is palpation a powerful tool that is essential to an evaluation? The literature would disagree. In a study done in 2012 by Maigne, Cornelis, and Chatelier entitled “Lower back pain and neck pain: Is it possible to identify the painful side by palpation only?”, 91 patients with one-sided low back pain and 94 patients with one-sided neck pain were examined by 2 physicians with manual medicine training. 

Here are the results: “The examiners correctly identified the painful side in 64.8% of the cases of lower back pain (a significantly better percentage than chance alone (i.e. 50%), P = 0.02) and 58.5% (P = 0.10) of the cases of neck pain.”

This shows that palpation can indeed help identify the painful side more than chance alone, but that it is very far from being a perfect tool, going as low as 58.5%, which is only slightly higher than chance.

Another study was done in 2015 by Walker et al. entitled “Interrater Reliability of Motion Palpation in the Thoracic Spine” and concluded that “interrater reliability was poor for motion restriction and pain” and that this “may have unfavorable implications for all manual therapists who use motion palpation to select patients appropriate for spinal manipulation”.

All of this does not say that we should throw palpation out the window, but that its use is limited and is only one tool among many in biomechanical assessments.

What about manual therapy?

Manual therapy is the act of using techniques involving the hands to knead and mobilize a patient’s muscles and joints. My primary goal as a physical therapist is to help my patient meet their goals. These are typically to reduce their pain, their stiffness, or to get stronger. What has helped my patients achieve these goals the most is an approach combining therapeutic education and exercise prescription (more on that in my second philosophy article).

This is not to say that I never use manual therapy in my in-person sessions: I do so very often. But it is far from being the most vital part of my treatments. Whenever I use manual therapy, I will always supplement this by teaching patients “self-manual therapy” techniques where they can use household objects such as soccer and tennis balls to reproduce the same technique I did on them during our session. This is all to stay in line with my second principle of physical therapy: to make my patients as independent in their rehab as possible. 

These “self-manual therapy” techniques can be shown and done in telerehab and, in the rare cases where actual manual therapy is best, we can always ask a willing household partner to assist under my supervision.

What is needed for telerehab

The preparation required for a telerehab session is less than you probably expect! Here are items that will help make your telerehab session go smoother:

1. A cellphone or a laptop with a webcam. This is preferable to a desktop since you will be asked to move the camera so I can have different views of your joints as we do our assessment.
2. A chair, a belt, a towel, a tennis ball, a pillow case, a kitchen counter, a pillow, a door well, and a broom. These may sound like random items, but they are used for very common therapeutic exercises, so having them close at hand would be useful.
3. Any exercise equipment you may have, such as dumbbells, kettlebells, and resistance bands.

Moving forward

If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.

If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at dannydinh.physio@gmail.com or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.

Further reading

Here are some suggestions of articles I have written recently, organized by topics.

An in-depth explanation of my physiotherapy philosophy: Part 1, Part 2

Neck pain: a case study, answering common questions from patients

Low back pain & sciatica: case study 1, case study 2

Knee pain: case study 1

Shoulder pain: case study 1

An explanation of referred pain

Why choose telerehabilitation

7 reasons why I love my profession

References: 

Maigne, J.-Y., Cornelis, P., & Chatellier, G. (2012). Lower back pain and neck pain: Is it possible to identify the painful side by palpation only? Annals of Physical and Rehabilitation Medicine, 55(2), 103–111. https://doi.org/10.1016/j.rehab.2012.01.001

Walker, B. F., Koppenhaver, S. L., Stomski, N. J., & Hebert, J. J. (2015). Interrater reliability of motion palpation in the thoracic spine. Evidence-Based Complementary and Alternative Medicine, 2015, 1–6. https://doi.org/10.1155/2015/815407

Images courtesy of: Wikipedia, iStock, Vic Studios, Fit Physiotherapy, Fort Healthcare