CAPTION: Telerehab has become a lifeline for injured workers. Most commonly, musculoskeletal diagnoses are treated effectively with telerehab; however, even complex diagnoses often see benefit.

By Michelle Despres, PT, CEAS II, CETS

COVID-19 took the world by storm, altering our daily routines and forcing us to reimagine how we live our lives – from going to work and family celebrations to medical treatment. In our new world of social distancing, technology has become the glue that holds us together.

Although this technology has been available for nearly 5 years, telehealth services were not widely adopted until the onset of COVID-19. Incredibly, 5% of the population used some form of telehealth during the pandemic. This translates to approximately 16.5 million new users, of which 88% said they would use telehealth services again.1

Changes to Perceptions & Regulations

Prior to COVID-19, there was limited adoption of telehealth by injured workers due to misperceptions, including the possibility of inferior outcomes, substandard care, and fear of technology. In addition, telehealth policies vary at state and federal levels, contributing to low use.

Following warnings issued by the Centers for Disease Control and Prevention (CDC) to healthcare professionals about the impending threat of COVID-19, alternative treatment options were explored to maintain patient recovery. In response, the Centers for Medicare and Medicaid Services (CMS) expanded its coverage of telehealth services and began removing barriers for adoption. Preliminary changes allowed telehealth appointments to be scheduled without an initial face-to-face visit, eventually expanding CPT codes to include physical therapy and clarifying billing options. In the end, telehealth laws and regulations changed more significantly in the 2 months following the onset of the pandemic than they had over the previous 10 years.

Product Resources

The following companies offer products and services that can be helpful for workplace ergonomics, industrial rehabilitation, and work injury assessment:

DSI Work Solutions Inc
www.dsiworksolutions.com

ErgoScience
www.ergoscience.com

JTECH Medical
www.jtechmedical.com

OPTP
www.optp.com

WorkWell Prevention & Care
www.workwell.com

Know Before You Go: Transitioning to Virtual Physical Therapy

Telerehab has played a vital role in the ongoing recovery efforts of injured workers during COVID-19. One Call experienced a 650% increase in telerehab referrals, including an 8% increase in referrals from adjusters and nurse case managers specifically requesting physical therapy to be delivered virtually.2

For medically fragile individuals, this remote offering provided security and peace-of-mind to continue treatment without risk of exposure, while others appreciated how it allowed them to recover or reduce scar tissue formation if surgery was postponed. In either case, telerehab provides benefits such as flexible scheduling, no travel time, and undivided attention from a therapist.

When transitioning to virtual physical therapy a common concern is that technology will be difficult to use. The learning curve is minimal, and the only technology needed is a smart device and access to the internet. After the initial visit, injured workers often feel at ease and comfortable continuing virtual therapy, even among older individuals. This year alone, 35% of recent telerehab adopters were 55 and older.3

Prior to the appointment, the provider sends an email with instructions on how to access the telerehab platform through a HIPAA-compliant web link. One Call also provides injured workers with a digital handout outlining what to expect during their appointment.

A telerehab appointment is facilitated just like a brick-and-mortar visit. The therapist meets with the injured worker to discuss the injury and any areas of concern. The therapist then evaluates, based on function and movement patterns. Instead of touching the injured worker, the therapist cues movements and watches how their body responds. Without the therapist physically present, injured workers take a more active role in their therapy sessions, better understanding their personal muscle composition and strength.

If therapeutic tools such as bands, cords, balls or weights are required for a telerehab appointment, they will be mailed directly to the injured worker.

Influencing Positive Return-to-Work Outcomes

COVID-19 gave telerehab the opportunity to shine. It proved to the industry and injured workers alike that it is a competitive, non-intimidating solution, generating positive return-to-work outcomes. Injured workers who receive telerehab attend 46% fewer visits than unmanaged cases, which represent an average cost avoidance of $838 per referral.4 By helping an injured worker recover from their injuries quickly, they can return to work and life faster.

During the pandemic, One Call heard from several injured workers who shared their positive telerehab experiences. During a time of so much uncertainty, it is rewarding to learn that many individuals felt physically and mentally stronger following their virtual physical therapy appointments. Here are two experiences shared:

Clavicle Fracture, Bilingual Translation Services

A construction worker suffered a triple clavicle fracture. English was not the primary language, so a Spanish-speaking physical therapist was provided. Following treatment, the injured worker had full range of motion and saw significant improvement to two non-injury related ailments. Nearly 67 million US residents speak a language other than English at home – the inability to communicate can result in inefficient care and delayed recovery.5

Rotator Cuff Injury, Cancelled Surgery

Rotator cuff surgery was postponed due to COVID-19. Concerned that the injury could get worse, doctors prescribed telerehab to reduce inflammation and scar tissue growth until surgery could be rescheduled. The injured worker underwent seven telerehab appointments to re-establish full range of motion, strength and function, conservatively. In the end, the injured worker was able to cancel their surgery, eliminating prolonged recovery time and thousands of dollars in medical expenses.

What Services Can Be Offered Remotely?

There are several physical therapy treatments that can be performed virtually, but it may not be the ideal solution for all injury types. Most commonly, musculoskeletal diagnoses are effectively treated with telerehab; however, even complex diagnoses often see benefit. In contrast, if an injured worker has balance deficits or weight-bearing restrictions, it may be appropriate for a care extender, such as a certified nursing assistant (CNA) or home health aide, to assist with safety measures, such as guarding with a gait belt during standing exercises or ambulation activities.

The effects of COVID-19 continue to be felt across the country, but the silver lining is that technology has played a significant role in keeping us connected and moving forward. Telerehab has become a lifeline for injured workers, and we see it continuing to be an invaluable tool as employers navigate the complicated waters of a new work environment. At One Call, the staff believes virtual therapy services don’t have to start only after an injury occurs. The organization utilizes this platform to provide safety and injury-prevention education as well. Ergonomic assessments are shared with new and current remote employees to evaluate workspaces and make adjustments as needed. Additionally, strength and conditioning programs, such as post-offer employment testing, are implemented to support employees as they return to work following furlough.

By utilizing existing tools and expanding virtual offerings, we can meet the needs of every worker while supporting the rebound of the American economy. PTP

Michelle Despres, PT, CEAS II, CETS, is a national clinical leader for One Call. Focused on physical therapy, Michelle shares her expertise about topics such as telerehab and physical therapy as an opioid alternative while encouraging patients to take an active role in their recovery. For more information, contact PTPEditor@medqor.com.

References

  1. PWC. The COVID-19 pandemic is influencing consumer health behavior. Are the changes here to stay? https://www.pwc.com/us/en/library/covid-19/covid-19-consumer-behavior.html#content-free-1-fe80
  2. One Call national data based on prospective referrals received from adjusters and nurse case managers in 2020.
  3. One Call national data based on prospective PT telerehab referrals successfully discharged from therapy in 2020.
  4. One Call national data based on prospective PT telerehab referrals successfully discharged from therapy in 2020.
  5. Camarota SA, Zeigler K. (2018, September 19). Almost Half speak a Foreign Language in America’s Largest Cities. Centers for Immigration Studies. https://cis.org/Report/Almost-Half-Speak-Foreign-Language-Americas-Largest-Cities