Guidelines: telerehabilitation in Physical Therapist (PT) Practice, from the American Physical Therapy Association

The American Physical Therapy Association (APTA) has released new guidelines regarding telerehabilitation in physical therapist (PT) practice.  

In the USA, telehealth is the use of electronic information and telecommunication to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. This encapsulates digital health (developing and using digital technology to improve health).  

The APTA has published seven recommendations based on research studies worldwide, covering a number of conditions that have successfully used telerehabilitation.  

The recommendations address efficacy, delivery, facilitators, barriers, and potential for adverse events surrounding telerehabilitation implementation within physical therapy. The evidence is varied, but it is recommended that PTs should assess their own knowledge and skills, and seek further training, when considering implementing telerehabilitation. However, it is seen as a positive service that, when implemented well, could be largely beneficial and allow PTs to accommodate patients with certain barriers.

Read on for a summary of each recommendation. For the full report and for further details, click here.

Recommendation 1 – patient satisfaction and acceptability

Telerehabilitation or hybrid care should be recommended to patients, as they are at least equivalent to in-person physical therapy with patient acceptability and satisfaction.  

According to the studies, patients are more likely to adhere to programs and attend telerehabilitation appointments than in-person appointments.  

Recommendation 2 – cost effectiveness

PTs and patients should discuss whether telerehabilitation is a cost-effective option compared with in-person care in the context of their circumstances and conditions.

For example, the studies found that in some instances, such as those with total hip arthroplasty/knee arthroplasty or heart failure, care costs were lower with telerehabilitation. Additionally, costs were saved for those who lived further away from the health care center, as the further the travel, the more it costs to get there.  

Under this recommendation, the benefits outweigh the risks/costs, but there are considerations that should be accounted for, and each patient case should be assessed thoroughly before a personalized decision is made.  

Recommendation 3 – reduce barriers for patients

PTs should identify and work to reduce barriers and promote facilitators identified from patient perspectives and experiences when planning and providing telerehabilitation services.

The facilitators identified by the patients studied include:

• better access to care
• increased flexibility, convenience
• scheduling benefits

Exercise can serve as a self-motivator, helping patients incorporate it into their daily routine. Also, patients felt more comfortable speaking with their therapists over the phone, for example.  

The barriers identified correspond to health conditions and severity levels, comorbidities, ages, familiarity with technology, and social demands. Some, like those in the acute phase after stroke, found setting up the required equipment too cumbersome, which is a demotivator.

Recommendation 4 – reduce barriers to the delivery of telerehabilitation services

PTs should identify and work to reduce clinician and organizational barriers and promote facilitators to support the delivery of telerehabilitation services.

Patient facilitators and barriers as perceived by PTs

According to PTs, patient facilitators include convenience and an improvement in access to care with telerehabilitation, especially for those traveling long distances or unable to leave their homes for in-person appointments. Additionally, there were indirect cost savings for patients needing time off work or childcare when attending in-person sessions and simple technology interfaces.

The barriers included poor internet connectivity, low health/digital literacy, issues with performing exercises without physical assistance, and receptiveness to telerehabilitation.  

Provider facilitators and barriers

Among those willing to provide telerehabilitation facilitators were clinician attitudes, skills, knowledge of the technology, and value of the service.  

However, barriers included issues around performing comprehensive assessments, particularly due to the lack of physical contact and the inability to observe patients fully. There were also concerns about the lack of evidence supporting telerehabilitation and issues around technology.  

Recommendation 5 – results can be used to inform diagnosis

When PTs perform components of examination via telerehabilitation, they may use the results to inform diagnosis with accuracy comparable to an in-person visit for certain health conditions.

The evidence comparing the diagnostic accuracy of telerehabilitation and in-person assessments is limited, but it is consistent. For example, the studies found that telerehabilitation for assessing range of motion and pain with motion in patients with low back pain was less likely to be as accurate as in-person assessments, but for overall assessments, they are similar. In addition, in-person and telerehabilitation were both consistently accurate in diagnosing musculoskeletal conditions.  

Recommendation 6 – achieve similar outcomes to in-person care

PTs should use telerehabilitation to achieve outcomes similar to in-person care for certain health conditions.

The studies showed that those with conditions such as Parkinson’s, Chronic Heart Failure, or Chronic Respiratory Disease saw no difference between telerehabilitation and in-person care, whilst those who experienced stroke or total knee/hip arthroplasty saw slightly more improvement with telerehabilitation.

Recommendation 7 – anticipate, prevent, manage, and document adverse events

PTs should anticipate, prevent, manage, and document occurrences of adverse events specific to telerehabilitation as the mode of delivery.

The studies found that those who experienced adverse or negative events saw no differences between the modes of delivery—whether PT or telerehabilitation. While recordings were minimal, they found that rates of these events were low in general.  

Integrating these recommendations

For those interested in integrating these practices, a thorough examination of the APTA's full report is essential. It provides an in-depth look at the potential and practicalities of telerehabilitation, equipping PTs with the knowledge to confidently implement these services. The journey toward a digitally enhanced physical therapy landscape has begun, and the APTA's guidelines are a beacon guiding us toward a future where distance is no longer a barrier to healing and wellness.

To read the full report here, click here.

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