How COVID-19 have changed physiotherapy care delivery ?

Mankind have seen many challenging twists and turn in it's history, like some theories say the early natural calamities that triggered mutation in the humanoids to develop cognition, like agriculture, like industries, like internet, and like AI may be. During these times, there were minor social transformations evoked by inventions, wars and pandemics that has crafted the current life of a man. COVID-19 is one such an event that is in the process of evoking another social transformation.

Healthcare, of all the profession that will undergo this social transformation, may have a whole new look, the care delivery model(Patient-centered to community centered), mode of care (manual to machine assisted or machine oriented), practice model (Evidence based medicine to Algorithm based medicine), financial modeling of health(optional to state imposed), and the very mission of healthcare (longevity to adaptivity) will be transformed. Physiotherapy would be an interesting sector to talk about from this transformed healthcare. There has been many articles on the general health care and it's reactions to COVID-19 by different countries, but this article will focus only on Physiotherapy care delivery across the nations.

Until 2020, physiotherapy care delivery across the globe is very different from country to country while impact of COVID-19 was also different from country to country. Although the barrier to physical contact reminded universal, the response of the impact was different. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In the figure below, conceptual framework of telemedicine for the coronavirus disease 2019 (COVID-19) pandemic, shows how Telemedicine can prevent contact while ensuring care delivery.

Meanwhile most of the countries were not ready, and their out-patient physiotherapy services reminded shut down. Even in countries with Out-of-pocket payment healthcare system, the clinicians were out of business, as either the therapists or the patients were not used to Telehealth care delivery,they also lacked knowledge and skills required for this novel type of health care delivery. For example, even in USA, according to CMS health care providers on the front lines of COVID-19 have identified that some older adults prefer telephone use to digital telecommunication interactions because of a lack of technology understanding and training.

In Australia, USA, UK, France, Canada, and Singapore, Physio consultations were already provided via Teleconsultations and they were reimbursed while also a temporary lift on some of the regulatory restrictions for e.g, In USA, the HHS allowed Non-HIPAA complaint private technologies like Skype to be utilized for Telehealth service provision. It was not the case in most other European, Asian and African countries, the telehealth was not adopted. In India, with it's huge middle class backed economy, physiotherapy being a non-essential service was not the main need for the people, while they were anticipating an already declining and a worsen post COVID-19 economic depression.

There is also and always exceptions everywhere, Physiotherapy of-course was essential to certain group of patients, who foremost of them was COVID-19 affected, who needed to have respiratory physiotherapy, the bed ridden neurological disordered persons. the pediatric cases were dependent on the therapy routine, post-operative and post-traumatic cases could easily fell into deformities without Physiotherapy consultations. so it obvious that physiotherapy services cannot remain shutdown and at the same time the risk of exposure and cross infection is also high. so this gave opportunities for some alternative mode of care delivery and also few innovations from therapists, recommendations, guidelines and regulatory frameworks from associations and organizations, innovative telehealth therapy management platforms etc.

Once such response was from WCPT, A joint digital physical therapy practice task force of the World Confederation for Physical Therapy (WCPT) and the International Network of Physiotherapy Regulatory Authorities (INPTRA) was convened in 2017 to develop key recommendations for global practice and regulation, resulting in a white paper approved by the WCPT and INPTRA boards on March 18, 2020. It defined a new term called "Digital Physical Therapy Practice" as health care services, support, and information provided remotely via digital communication and devices. the purpose of digital physical therapist practice is to facilitate the effective delivery of physical therapy services by improving access to care and information and managing health care resources. For this reason, WCPT contend that this definition and purpose is broader in global scope than that of telehealth, telerehabilitation, and telemedicine. Please read the above report for more insight.

Another example can be quoted from Singapore Physiotherapy Association's Telehealth guidelines, Indian Physiotherapy Association has also recommended to conduct a Pre-appointment video-consultation to obtain history, including Triage, Self-declaration and when suited then provide an in-person care delivery. This crisis has also given rise a new form of Telerehab, developed by a group of young rehab professionals called Pro eRehab, with the advent of Teleconsultation, these young minds have innovated to collaborate and provide a multi-dimensional (Physiotherapy, Speech Therapy and Occupational Therapy) care to the service user. They are also extending their services and teams internationally, paying way and setting an example to global collaborative telehealth.

Now the stage is set, the world of Physiotherapy care delivery is changing, and what is more to be expected, is not just the Teleconsultation, there has been recomendations to CMS (Centers for Medicare and Medicaid Services) for the reimbursement of texting, emailing, use of chatbots, remote patient monitoring and, Hospital-in-home for quarantined patients etc. Any relevant payment rules should allow for creative applications of emerging digital technologies, such as voice-interface systems (Amazon Alexa, Google Voice, Apple Siri) or mobile sensors such as smartwatches, oxygen monitors, or thermometers. As we have seen with Pro eRehab, there would be numerous global collaborative telehealth opportunities and the payers should be able to expand reimbursing beyond borders and regulatory jurisdictions.

When the global telehealth is embraced, patient data obtained via traditional tests, and observations are not enough, we would need machine generated data like from your wearables and mobile, that could be comprehended to predict your health rather than monitoring, Physiotherapy then will never be just for persons who needed care, it will be delivered to persons who are susceptible to use more healthcare services in order to avoid them putting more load on the healthcare system, it will be become preventive, and will be targeted via algorithm rather can symptoms after becoming an user of the health care system, does this remind you of the movie "Minority report", we are not very far.

Recommendations to go forward :

1. The integration of telemedicine into international and national guidelines for public health preparedness.
2. Regulation and reimbursement of International Telehealth services.
3. Health data education to patients and providers in-order to promote the reliance of Patient generated health data, self reported health data via chatbots, community health data and health trends including flu and seasonal infections.
4. A strategy and operational plan guiding health care providers to switch to outpatient teleconsultations and increase tele-expertise and remote patient monitoring.
5. A communication toolkit to inform and educate the population on the recommended use of telehealth
6. A data-sharing mechanism to integrate telehealth providers’ data with epidemiological surveillance nationally and internationally.
7. A scientific evaluation framework and dedicated research funds to describe and assess the impact of telemedicine during outbreaks

Footnote: Physio Plus Tech is originally a Physiotherapy Clinic management software providing it's services in India and Singapore, now we have launched the free telehealth portal to support our clients. To know more visit : https://www.physioplustech.in

References:

1. Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health Surveill. 2020;6(2):e18810. Published 2020 Apr 2. doi:10.2196/18810
2. Pedersini P, Corbellini C, Villafañe JH. Italian Physical Therapists' Response to the Novel COVID-19 Emergency [published online ahead of print, 2020 Apr 13]. Phys Ther. 2020;pzaa060. doi:10.1093/ptj/pzaa060
3. Alan Lee, Digital Physical Therapy Practice Task Force, COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth, Physical Therapy, , pzaa079, https://doi.org/10.1093/ptj/pzaa079
4. Sirina Keesara, M.D., Andrea Jonas, M.D., and Kevin Schulman, M.D., COVID-19 and the Health care's Digital Revolution, The new England jounral of Medicine, April 2, 2020, DOI: 10.1056/NEJMp2005835
5. https://www.cms.gov/files/audio/covid19lessonsfromthefrontline04032020.mp3