Chase Kuhn

On May 19, Neville M. Bilimoria published an article here touting the benefits of telehealth in rehabilitation. 

Mr. Bilimoria made some great points in his article, but his description of traditional in-clinic care as “seemingly antiquated” wasn’t one of them. While it’s clear that telehealth services offered by a physical therapist can be beneficial for certain patients and certain conditions, if we wholly dismiss in-person, in-clinic care as “antiquated,” we do so at the peril of our patients. 

To be sure, there are many pluses to telehealth. As outlined in a paper published by the American Physical Therapy Association, The Digitally Enabled Physical Therapist, using digital tools such as telehealth can, among other things, increase patient access to care, drive better patient engagement, decrease cost burdens such as travel times, and allow more scheduling flexibility.  

But those benefits, while numerous, are also nuanced. And the clinical reality is, they don’t and can’t always outshine the benefits of in-person care. 

In fact, in-person care should be considered the standard for physical therapist and physical therapist assistant services. Significant portions of physical therapist treatment involve direct contact, whether it’s offloading a patient’s body weight as they stand from a chair, facilitating movement of a limb as part of rehab after a stroke, identifying a taut muscle band through manual palpation, or providing tactile cues to correct a problematic movement pattern. These interventions, used by therapists nationwide every day, are nigh impossible via current screen to-screen digital technology. 

This isn’t a zero-sum relationship. The idea that in-person care is important shouldn’t be seen as a rejection of telehealth’s value; in fact, it’s the opposite. The many patient benefits of telehealth are more fully realized when in-person care can establish the most effective treatment options and use telehealth when it is the most appropriate, most patient-centered tool. 

It’s not just about which interventions work via telehealth and which ones don’t, however; it’s also about patient access to care. While telehealth can help increase access for rural and underserved populations, there are practical considerations that must be weighed. Many of the same areas that could benefit from telehealth lack the tools required, such as the equipment and high-speed internet that make telehealth possible. These factors may make telehealth a less desirable option, if not an impossible one. 

Patient choice is also a major consideration. Some may be uncomfortable or unwilling to participate in digital services. Providers need to respect and honor patient self-determination, even if that means providing in-person care when telehealth may work just as well.  

What our patients need is a blended approach, with the decision as to which delivery method is best suited for the patient and the plan of care made jointly by clinician and patient.

It’s also important to acknowledge digital health’s potential risk to the public when provided without sufficient oversight — for instance, when a product attempts to imitate skilled physical therapist care. Regardless of delivery model, physical therapy must be provided by a licensed physical therapist or by a physical therapist assistant under the supervision of a physical therapist.  

Wellness apps and devices that provide exercises without the oversight of a licensed physical therapist are not physical therapy. These tools can certainly provide meaningful health benefits, but they should not be confused with physical therapy as delivered by a licensed professional. The power and potential of telehealth shouldn’t be diminished through misrepresentation of what does and doesn’t constitute competent care. 

Americans need and deserve access to in-person care. Because in-person care can be more medically appropriate or better aligned with a patient’s values, it’s crucial that we maintain a robust system of traditional rehabilitation services. Leaning exclusively on digital health delivery creates ripple effects that can hinder nursing homes and physical therapy clinics that operate under standard practice models. Threatening these businesses threatens every patient’s access to in-person care. 

When a provider is digitally empowered, informed, and enabled to increase accessibility and availability of physical therapist services, they can improve patient care and drive better healthcare outcomes. Proper use of the ever-expanding digital tools available to PTs and PTAs presents an exciting opportunity to better serve both the needs of facilities and the needs of our patients. But characterizing traditional delivery models of care as antiquated is a dangerous misrepresentation of what it means to provide clinically appropriate, patient-centered care. 

Chase P. Kuhn, PT, DPT, is a health policy and payment specialist at the American Physical Therapy Association. Chase received his Doctor of Physical Therapy degree with specialization from the Ohio State University and subsequently participated in their orthopedic physical therapy residency program.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.