Does Digital Physiotherapy Even Work?

Does Digital Physiotherapy Even Work?

By Amy Gillespie, Physiotherapist

There is a growing body of evidence that telehealth or digital physiotherapy can be effective in treating musculoskeletal injuries (those injuries of the joints and muscles – such as back pain, knee pain, muscle strains).  There has also been a shift in physiotherapy treatment towards exercise based rehabilitation and education which is also supported by the evidence.  Both exercise based rehabilitation and education are treatments that can easily be adapted to the digital physiotherapy consultation.  We know that for some people they aren’t able to access traditional physiotherapy services and that telehealth is the only viable option for them to have access to a skilled physiotherapist for assessment, diagnosis and treatment.  But is it effective?  A number of recent studies have shown, that yes, digital physiotherapy is as effective and in some cases is more effective than face-to-face physiotherapy.  There are also a number of studies that show that we are able to accurately assess and diagnose musculoskeletal injuries via a video consultation.

A recent (2018) Australian study looked at assessment and diagnosis of chronic lower back, knee and shoulder pain in patients.  In the study patients were assessed in person and then via a video consultation by different physiotherapists.  What the study found was that there was a high level of agreement in terms of clinical management and diagnosis between the in person and digital assessments.  The study concluded that telehealth can be considered an effective and viable option for those patients that are unable to access traditional face-to-face care.  Another Australian study from 2015 looked at the accuracy of undertaking assessment of the knee via a video consultation compared to face-to-face assessment.  Again, similar to the first study, the authors found that there was a high level of agreement between digital consultation and face-to-face assessment.  In 67% of the cases there was an exact agreement between digital and face-to-face and in similar in 89% of cases.

In 2018 researchers in America looked at assessment in person compared to a video consultation for teenagers who have had knee surgery.  They were looking at whether there were any differences between how the wound was healing, the amount of swelling and the range of motion a patient had following surgery.  It was found that there was 100% agreement between face-to-face and telehealth assessments for wound healing and swelling.  Range of motion between groups was found to be similar as well.  In 2016, Chinese researchers conducted a review of research that existed, looking at how telehealth compared to face-to-face rehabilitation following a knee replacement.  They found that telehealth was able to achieve similar levels of pain relief, improved levels of functional improvement with activities of daily living and also achieved higher improvements in knee extension range of motion and thigh strength.

In 2019 another group of Australian researchers in Brisbane compared the results of physiotherapy rehabilitation delivered in person compared to via digital consultation following a hip replacement.  Digital physiotherapy was found to be as effective as in person rehabilitation following hip replacement.  Both forms of physiotherapy showed high levels of patient satisfaction and interestingly there was a higher level of compliance in the telehealth group, meaning they attended their appointments and completed their exercises more regularly than the face-to-face group. 

In terms of the type of physiotherapy treatments that telehealth can provide the big two are exercise and education.  A tailored exercise programme that is prescribed for the individual patient and their injury/pain is a key component.  This exercise programme is then able to be reviewed as needed through the recovery period.  Education consists of education about the injury, expected recovery timeframes, pain and whether or not pain is hamful, pacing activities and gradually easing back into activities as the injury allows.  In a 2017, review of evidence it was found that for most injuries and pain, treatments such as exercise therapy and education, produced medium to large effects (improvements) in both pain and function for patients.  They concluded that the best available evidence showed that patients with musculoskeletal pain can be managed effectively with treatments that include self-management advice, education and exercise therapy.  

You can see there there is a lot of research showing support for the effectiveness of digital physiotherapy and this is just increasing as the telehealth becomes more mainstream.  Any questions, feel free to get in touch with me at amy@thedigital.physio.

References:

Abel, K., Baldwin, K., Chuo, J., Wells, L., Ganley, T. J., Kim, A. Giordano, T.  (2018). Can Telemedicine Replace the First Post Op Visit for Knee Arthroscopy in Adolescents? Pediatrics, 141(1), 663. DOI:10.1542/peds.141.1_ MeetingAbstract.663

Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J (2017) Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS ONE 12(6): e0178621. https://doi.org/10.1371/journal.pone.0178621

Cottrell, M. A., O’Leary, S. P., Swete-Kelly, P., Elwell, B., Hess, S., Litchfield, M., McLoughlin, I., Tweedy, R., Raymer, M., Hill, A. J., Russell, T. G. (2018). Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Musculoskeletal Science and Practice, 38, 99-105. https://doi.org/10.1016/j.msksp.2018.09.014.

Jiang, S., Xiang, J., Gao, X., Guo, K., & Liu, B. (2018). The comparison of telerehabilitation and face-to-face rehabilitation after total knee arthroplasty: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 24(4), 257–262. https://doi.org/10.1177/1357633X16686748

Nelson, M., Bourke, M., Crossley, K., Russell, T. (2020). Telerehabilitation is non-inferior to usual care following total hip replacement — a randomized controlled non-inferiority trial. Physiotherapy 107, 19-27. https://doi.org/10.1016/j.physio.2019.06.006

Richardson, B. R., Truter, P., Blumke, R., & Russell, T. G. (2017). Physiotherapy assessment and diagnosis of musculoskeletal disorders of the knee via telerehabilitation. Journal of Telemedicine and Telecare, 23(1), 88–95. https://doi.org/10.1177/1357633X15627237