2 Key Questions
Prime Minister Scott Morrison announced further restrictions on businesses in Australia on Tuesday night in the effort to slow the spread of CoVID-19. In his address, physiotherapy is deemed an essential service, but is physio really essential? Let’s take a look.
In order to answer this question, we must consider two important questions.
- If the patient does not receive physiotherapy, will this lead to (i) a permanent loss of function, (ii) a deterioration of their quality of life (QoL) which threatens their life?
- Must interventions be delivered in person?
Here’s a quick and non-exhaustive list of YES cases to question 1.
|Respiratory patients e.g. Emphysema, Chronic Obstructive Pulmonary Disease, Cystic Fibrosis|
Cancer patients e.g. Lymphodema Management
Neurological patients e.g. Stroke rehab, Acquired Brain Injury rehab
|Acute musculoskeletal pain and injuries e.g. Sciatica, acute sports injuries|
Patients on the left of this table are typically seen in hospitals or specialised centres attached to a hospital, as hospitals are most certainly an essential service, these patients will continue to be treated.
Patients on the right of this table are commonly seen in private clinics so the next question is – MUST they be seen in person? The answer is no.
Time to Innovate
Physiotherapists are most famous for our manual therapy skills, but hands-on treatment is only one component of physiotherapy! In fact, the most essential aspects of physiotherapy are assessment, education, advice, prescription and progression of appropriate movement leading to recovery or self management, NONE of these require in-person consultation. They can all be safely and effectively delivered via telehealth. In fact, most conditions traditionally seen in-clinic can be effectively managed without in-person consultation with some creativity and innovation!
Early in my physio career I worked with a lot of oldies through the Department of Veteran Affairs (DVA), I have fond memories of this bunch and I found myself thinking of them lately as they are without a doubt the most vulnerable during this crisis. I pondered how I can manage their needs if I were still working with them and this is one example:
Mary (not her real name) is a vibrant lady in her 70s who used to come see me twice a week for chest physio to help manage her emphysema. She also has diabetes and heart disease.
In a typical session, I’d listen to her chest, perform percussion and vibration techniques on her, and guide her through breathing exercises and physical exercises. She’d generally have a decent cough and then reluctantly let me have a look at her sputum (she often has an underlying chest infection), and then off she goes.
Here’s the double-edge sword: Mary is a high risk patient in this CoVID-19 crisis, however, if her lung function deteriorates because she can’t access physio, she may even be more compromised!
If I were still treating Mary today, I’d attempt to manage her via telehealth. For her safety, there should be a family member present during these telehealth sessions. I won’t be able to listen to her chest but I can have a detailed discussion with her about her symptoms. It has been 16 years since I’ve worked with Mary and nowadays health monitoring equipment such as pulse oximeters are widely available so I’d source one for her. I can teach and supervise her family members to perform some simple techniques; it is actually quite common for a family member of a person with a chronic respiratory condition to learn how to do these techniques, and they get quite good at it with practice the same way how I got good at it with practice. In fact, I’ve seen better percussion done by well-practised family members than new-grads.
Breathing and physical exercises can also be supported by family members and supervised by physio over the screen. Respiratory patients are generally good at gauging their own lung function, and if they feel poorly, they know they need to see their doctor, not their physio. My point is, it is possible to manage Mary via telehealth, or at least try to reduce the number of in-person visits needed at a time where social distancing is of utmost importance, it will go a long way in slowing the spread of CoVID-19 and importantly, help protect vulnerable members of our community, like Mary.
What about Manual Therapy?
“But it really hurts!”
Pain sucks. It truly does. As a physio, helping people out of pain is what I do. “It doesn’t hurt anymore” is easily my favourite sentence I hear from my patients, it warms my heart. That said, the severity of pain does not automatically provide a YES to question 1 above. Severe pain does not imply an imminent permanent loss of function or a deteriorating of QoL that will lead to death. To put it bluntly, you might feel like you are dying, but your hurty bit is not going to fall off and you’re not going to die. I estimate only about 1% of all my patients in 20 years of private practice physiotherapy are a Yes case in question 1.
“But I need my physio’s hands to fix me!”
This is the perfect time to bust myths about manual therapy. Let’s see what manual therapy does and does not.
|Things need to be popped back in.|
Things can be popped back in place.
You need to be realigned.
Tight muscles can be released.
|Manual therapy helps calm down your nervous system and contributes to a temporary reduction in your pain experience and alleviates your sensation of tightness and stiffness.|
The power of touch, manual therapy, rests in its soothing effect on your nervous system. The more you trust and like the person providing the touch, the bigger the result. Remember manual therapy is only what physios are most famous for, the true value we provide is in assessment, education, advice, and movement, all of which can be delivered via telethealth.
These are trying times. According to experts all over the world and what we can see from what other countries are doing and how they are faring in this pandemic, social distancing is of the utmost importance and urgency. We must try our hardest to minimise the movement of people across our community. We must all do our part. We must stay home unless we need food, medicine, in-person medical care, or you’re an essential worker.
The good news is that the telehealth is here! WorkCover has approved telephysio in Queensland, Victoria, NSW, and other states are expected to follow suit. Minister for Health Greg Hunt MP is set to announce Stage 4 of the Government’s Expansion of Telehealth Services in coming days which will see it extended to include allied health. And most excitingly, Private Healthcare Australia has earlier today announced that “Health funds will provide coverage for teleconsultations provided by physiotherapists from Tuesday 14 April 2020 subject to conditions.”
Physios across the country are working very hard to be telehealth ready. When I looked at doing telehealth last year, before I decided to focus on a YouTube health channel and eBooks, I spent months researching and testing systems to make sure I can deliver telehealth safely and securely, even with all the background work already done, if I were to roll out telehealth now it will still take a good few days to get organised. Most of my colleagues are starting telehealth from scratch so please be patient, it is coming and I highly encourage everyone, physios and patients, to use it.
Stay home and save lives.
’Til next time, Be Free In Your Movement™.
This information is not medical advice. Got health concerns? Consult a real-life health professional.
Views are my own.