5. Virtual Care Practice Questions
Virtual care can be used to provide much value, however, there are limitations and some situations will require in-person care. Patients should be informed of this during the consent process. Decisions made will always require clinical judgement for the best course of action given a particular patient, condition, and treatment/assessment goal with a consideration of the safety and value of the assessment proposed. The physiotherapist must make the decision about whether or not it is safe to proceed with virtual care.
Depending on the job, safely assessing functional abilities is a more difficult task than performing virtual versions of standard musculoskeletal tests. We are not aware of any research speaking to the validity/reliability/safety of doing functional assessments for RTW virtually. In some cases, such as in the case of more sedentary jobs, you may be able to assess these abilities. But as the tasks get heavier, the logistics and safety of virtual care become more of a concern. If a physiotherapist does not feel the assessment of functional abilities is likely to be accurate or safe, or is simply not logistically feasible, they should advise the referral source and patient of this and opt for an in-person assessment. It is quite possible this will delay RTW, but a physiotherapist simply cannot provide unsafe/ineffective virtual care – in-person or virtually.
There are many studies that look at the validity of telehealth assessments versus in-person assessments. Many of these studies are conducted by the University of Queensland’s Centre for Research in Telerehabilitation. For a primer on some of these studies, please refer to the Alberta Physiotherapy webinar with guest Dr. Trevor Russell from the University of Queensland.
While we can likely expect formal, systematized methods of assessing via virtual care to develop in the near future, to date these have not yet been developed. Your best approach to gain clinical knowledge is to take a course from a physiotherapist/clinician who has experience in the field and has developed their own systems. Possibilities include:
1. Natasha Wilch (Canada)– Clinician’s Course for Telehealth
2. Karrin Finnin (Australia) – How to Set Up a Telehealth Service
Due to COVID-19, there are a great many physiotherapists entering virtual care practice with very little experience. We have encouraged significant caution in the use of recording either images or video as there is enough to be concerned about without adding this layer of complexity. Recording increases the potential for privacy issues, primarily due to the fact that recording now has to be stored and secured. However, if there is a good clinical reason to do so, a recording can be done with an appropriate explanation to the client and express consent for this purpose. Please refer to the consent section in the Virtual Care Toolkit. The physiotherapist and patient should understand and accept the increased risk and associated with recordings.
For example, a patient who would like me to observe his perineum to see if he is contracting his pelvic floor correctly.
CPTBC has suggested for this scenario, given the high impact of a privacy breach in this context (particularly since the patient’s face is likely also visible at some point in the interaction), and the increased potential for misunderstanding, or where the patient is a minor, that observation of the pelvic floor via telehealth should be avoided. Exceptional circumstances may arise from time to time where this could be contemplated and if the procedure is to be performed, it is suggested to do it in consultation with the College.
Virtual care visits will often take longer than their in-person equivalents and even experienced physiotherapists will build in extra time for these assessment sessions. A common formula is to increase your in-person visit time by approximately 1/3 (for example, a 30-minute in-person assessment, becomes a 40-minute virtual care assessment). However, this will vary by the experience and practice patterns of the physiotherapist.
