Are online consultations worthwhile?

How can we use online consultations to improve outcomes from physiotherapy?


1. Triage

This is the process of sorting and allocating treatment. Physiotherapists are first contact practitioners. This means that we are trained in the assessment and diagnosis of musculoskeletal conditions, without clients needing to see another professional first.


With our expertise, physio's can have an important role to play in reducing unnecessary appointments with family doctors, and unnecessary trips to the hospital.  Through simple questioning and screening tests, we can advise on how to manage injuries and whether or not further investigations are needed. Physiotherapists have taken roles in Emergency Rooms across many countries, and the research shows that it can reduce wait times, reduces the need for imaging, and improves outcomes.


2. advice for acute injury management

Are you experiencing back pain for the first time? Is your shoulder hurting after your last gym session? Did you twist your ankle whilst walking?


Early intervention in all these examples is important for getting positive outcomes. Unfortunately, due to low access to services, time, money, and many other reasons, a lot of these cases do not get seen to quickly enough and they turn into longer-term and persistent issues. What if a quick call to a physio for some simple advice was available, meaning you didn't have to take time off work to get to the hospital, or wait in line for hours, or wait multiple days for a doctor's appointment?


The saying "a stitch in time saves nine" is one of my favorites and definitely applies to these situations.


3. education on the management of persistent pain conditions

It is well known that with persistent pain conditions that good education is an essential component of the treatment process. Why can't education be done over the phone or online to save time and money? Maybe your treatment plan is to see a physiotherapist every week for 6 weeks. What if 1 or 2 of these appointments were for education only and could be done at home over the phone or online? This would save money and be more accessible for the client.


4. alongside "standard" face-to-face physiotherapy consultations

As I mentioned above, a lot of the time physiotherapy is recommended over a period of time. We fully understand that the cost of this can build up, and with the dwindling amounts of insurance available, this leads to a lot of incomplete treatment plans. I think we could be complementing our standard face-to-face physiotherapy appointments with cheaper online and phone consultations. This will allow us to continue to provide care for longer periods of time, maintain accountability for the treatment plan, and continue to educate and advise on symptoms and progress. Yes, we can not perform manual therapy, or acupuncture, or a whole bunch of other techniques like this, but we can review and progress exercises as well as educate on conditions! I think that if we combined standard and online/phone care together then we will get better outcomes overall!


5. preparing exercise programs

There are some cases when the client just wants an exercise program to work on. For example, I get high school athletes wanting to improve their performance, as well as desk workers who want some exercises to do at the desk. It is completely reasonable in these cases to perform screening questionnaires and movement tests online, and then provide a tailored exercise program for them!


Over the past few months I have been thinking about ways to provide telephone and online consultations to clients, and the reasons above are just some of the benefits I think this will provide. Telephone consultations and online appointments are being used across numerous health care systems with good effect. Research suggests that the outcomes can be “no different” to standard physiotherapy care and that it reduces the cost of care.


I think that it has been important as a profession to start developing a system for online consultations. They are used very effectively around the world, but Canada has been resistant up to recently and this is likely because of insurance companies! Get used to online physiotherapy being a real thing, it is here to stay, and if done well is extremely effective.


Thanks for reading and please reach out to me with any physiotherapy questions at all! My reach is now further than just Collingwood so I am here to help.

Matt The Physio :)


References

McClellan CM, Greenwood R, Benger JR. Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department. Emergency Medicine Journal. 2006;23:384-387.


McLellan CM, Cramp F, Powell J, Benger JR. Extended scope physiotherapists in the emergency department: a literature review. Physical Therapy Review. 2010; 15 (2).


Sohil P, Hao PY, Mark L. Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain. World J Emerg Med. 2017;8(2):110–115. doi:10.5847/wjem.j.1920-8642.2017.02.005

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