New Telehealth Research: Best Use Cases and Current Limitations 
The increased use of telehealth services during the Covid-19 pandemic has led to an explosion of research on the topic, with some providers, including rehabilitation professionals, questioning its efficacy and feasibility. (1)
Today, we’ll delve into the currently available research to consider what telehealth in 2021 can and can’t do for providers and patients in the rehab realm.
What Is Telehealth in 2021?
While telehealth has gained prominence as a treatment modality during the public health emergency (PHE) of the coronavirus pandemic, its origins in the United States can be traced back at least as far as the Civil War, when military doctors used the telegraph to transmit messages regarding casualties and medical supplies. (2)
So, how exactly do we define telehealth in 2021?
Most experts agree that modern telehealth involves the use of electronic communications technology to support clinical healthcare at a distance. (3,4)
Importantly, many definitions also include the electronic delivery of health-related education and public health information under the umbrella of telehealth. (3,4)
Prior to the emergence of Covid-19, telehealth was not widely accepted as a method for the delivery of rehabilitation services. In fact, neither physical nor occupational therapists were approved as telehealth providers under regulations for the Centers for Medicare and Medicaid Services, or CMS. (5,6)
In light of the risks posed by in-person care during the height of the pandemic, CMS authorized PTs, OTs, and SLPs to provide and bill for telehealth services in the spring of 2020. (5)
However, these permissions were restricted to the duration of the public health emergency. It remains unclear whether CMS will continue to cover these services after the pandemic. (5)
Professional organizations are now working at the state and federal levels to push for continued coverage of telehealth for rehabilitation services in the post-Covid world (6).
What Does Research Say About Telehealth’s Use Cases and Limitations in 2021?
Advocates of telehealth are backed by a wealth of data showing high satisfaction levels and favorable outcomes from both physical and occupational therapy services that were delivered remotely during the pandemic. (6-8)
Researched Use Cases and Benefits of Telehealth
One interesting pilot study assessed data from 18 patients who received occupational hand therapy via a combination of telehealth and in-person appointments. The data demonstrated >80% agreement between the virtual and face-to-face results on objective measures like limb function, scar condition, and identification of pain location. (8)
Basically, the data from that pilot study show that regardless of what a provider’s initial instincts on the efficacy of telehealth are, it can be as clinically effective in observable client outcomes as traditional in-person care.
Perhaps the strongest argument for the use of telehealth in rehab spaces is its ability to contribute to achieving the triple aim of improving healthcare defined under the Affordable Care Act. (9)
1. Providing a positive care experience
Multiple studies have demonstrated no difference between patient satisfaction between those receiving in-person or telehealth PT. (7,8,10)
Providers also reported high satisfaction, noting the particular benefit of being able to see and treat patients in their natural home, work, or school environments. (9)
2. Improving population health
Telehealth can improve access to services, particularly in rural and underserved locations, where a dearth of providers would normally require patients to travel long distances to receive care. (8)
Particularly in cases in which patients have additional barriers to transportation, such as neurological deficits that prevent them from driving, telehealth can help bridge the gap of access to regular rehab care. (11)
3. Reducing the cost of care
By reducing the expenses related to travel and time required for a traditional clinic visit, telehealth can cut costs for patients. (11) This is particularly valuable for rehabilitation, in which outpatient visits are often prescribed at 2-3x/week frequency.
Current Limitations of Telehealth in 2021
Despite all the potential benefits of telehealth, some providers still have concerns about its use in rehab. Let’s consider three commonly cited weaknesses.
1. It can be difficult to ensure compliance with state laws and HIPAA
State laws regarding the use of telehealth by PTs and OTs vary widely. (3) If you choose to offer telehealth to your patients, you’ll need to understand and stay current on your state’s regulations.
HIPAA compliance is always a concern when the internet and healthcare mix. Fortunately, new technologies are continually emerging to address this issue. The AC Health App is an excellent example, as it allows therapists and patients to communicate via video, photo, and text in a HIPAA secure fashion.
2. The capacity for a physical exam is limited.
In a virtual visit, you obviously can’t use your hands to examine patients as you would in the clinic. While this does not mean that you can’t perform an examination over video, it will require some modifications.
Some providers argue that their hands-on skills are paramount to their treatment methodology, and thus feel that telehealth limits their capacity to help patients. (1)
3. Additional training time is required to master the associated technology
To employ it effectively, therapists will need to undertake training on the platforms used for delivering telerehab. (11) This upfront time investment may be a burden for many busy providers.
Emerging technologies can help act as therapists’ eyes and hands in the remote setting, by tracking patients’ movements and their performance of therapeutic activities (11, 12). However, these technologies also require additional training time for optimal use. (11)
Simple Ways to Incorporate Telehealth Into Your Practice Today
You’ve considered some important pros and cons of telerehabilitation. Now, let’s say that you’ve decided that the benefits outweigh the downsides.
How can you start using telehealth at your practice?
Your patients who are traveling long distances to the clinic or who have difficulty securing transportation will appreciate the option of some follow-up visits that can be performed virtually. (8)
Use telehealth to involve caregivers in your patient’s recovery.
Many pediatric therapists found that the telehealth format encouraged parents to become more actively involved in their child’s therapy and home program. (6) The same principle could help caregivers of older adults better understand how to contribute to their rehab.
Make use of intuitive, simple technology to augment your patient’s experience.
For example, the AC Health App makes it easy to send videos and instructions to your patients asynchronously, improving their understanding of their home program and increasing HEP adherence between clinic visits.
By embracing the flexibility and convenience of telehealth, you can offer your patients a more well-rounded and inclusive approach to rehabilitation. To learn more about combining telehealth with a traditional clinic model, check out our article on hybrid healthcare.
1. Dunning, J. (2020, April 9). Telehealth PT & COVID-19: Short-term fix, not the long-term solution. OSTEOPRACTIC. https://osteopractor.wordpress.com/2020/04/08/telehealth-pt-covid-19-short-term-fix-not-the-long-term-solution/ 2. Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530 3. Bierman, R. T., Kwong, M. W., & Calouro, C. (2018). State Occupational and Physical Therapy Telehealth Laws and Regulations: A 50-State Survey. International Journal of Telerehabilitation, 10(2), 3–54. https://doi.org/10.5195/ijt.2018.62694. 4. Lee, A. C. W., & Harada, N. (2012). Telehealth as a Means of Health Care Delivery for Physical Therapist Practice. Physical Therapy, 92(3), 463–468. https://doi.org/10.2522/ptj.20110100 5. Lee, A. C. (2020). COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth. Physical Therapy, 100(7), 1054–1057. https://doi.org/10.1093/ptj/pzaa079 6. Dahl-Popolizio, S., Carpenter, H., Coronado, M., Popolizio, N. J., & Swanson, C. (2020). Telehealth for the Provision of Occupational Therapy: Reflections on Experiences During the COVID-19 Pandemic. International Journal of Telerehabilitation, 12(2), 77–92. https://doi.org/10.5195/ijt.2020.6328 7. Miller, M. J., Pak, S. S., Keller, D. R., & Barnes, D. E. (2020). Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic. Physical Therapy, 101(1). https://doi.org/10.1093/ptj/pzaa193 8. Worboys, T., Brassington, M., Ward, E. C., & Cornwell, P. L. (2017). Delivering occupational therapy hand assessment and treatment sessions via telehealth. Journal of Telemedicine and Telecare, 24(3), 185–192. https://doi.org/10.1177/1357633×17691861 9. Cason, J. (2015). Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform. American Journal of Occupational Therapy, 69(2), 6902090010p1. https://doi.org/10.5014/ajot.2015.692003 10. Eannucci, E. F., Hazel, K., Grundstein, M. J., Nguyen, J. T., & Gallegro, J. (2020). Patient Satisfaction for Telehealth Physical Therapy Services Was Comparable to that of In-Person Services During the COVID-19 Pandemic. HSS Journal ®, 16(S1), 10–16. https://doi.org/10.1007/s11420-020-09800-5 11. Peretti, A., Amenta, F., Tayebati, S. K., Nittari, G., & Mahdi, S. S. (2017). Telerehabilitation: Review of the State-of-the-Art and Areas of Application. JMIR Rehabilitation and Assistive Technologies, 4(2), e7. https://doi.org/10.2196/rehab.7511 12. IANCULESCU, M., ANDREI, B., & ALEXANDRU, A. (2019). A Smart Assistance Solution for Remotely Monitoring the Orthopaedic Rehabilitation Process Using Wearable Technology: re.flex System. Studies in Informatics and Control, 28(3). https://doi.org/10.24846/v28i3y201908
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