Virtual physiotherapy sessions should be used more widely post-Covid, study finds

Virtual physiotherapy services should be seen as a viable alternative to in-person sessions beyond the Covid-19 pandemic, with research finding that patients who were treated virtually experienced a significant reduction in pain.

A study by physiotherapy organisation Ascenti found patients who had only been able to access treatment virtually saw pain intensity, measured on a numerical rating scale (NRS) of 10, improve by an average of 3.1 points without any manual therapy.

Those who received only in-person therapy before the coronavirus lockdown saw a 3.4 point improvement.

However,  patients that combined face-to-face treatment with virtual sessions delivered through the app saw the biggest improvements, moving from a 5.4 NRS score at initial assessment to 1.8 at discharge– an improvement of 3.6 points on average.

Ascenti suggested that these findings supported the idea that engagement in exercises improved outcomes for physiotherapy patients over and above any manual treatment given at in-person appointments.

Patients whose anonymised records showed they accessed exercise videos through an app as part of their virtual treatment saw the biggest improvements in every severity category (low, medium and high NRS).

Overall, 92% of the patients who were treated virtually were satisfied with its effectiveness, compared to 97% who received face-to-face treatment. However, Ascenti said it was “likely that the gap will close further as trust in virtual physiotherapy increases”.

Its report said: “While patients attending an in-clinic appointment often expect hands-on treatment, virtual physiotherapy enables a more holistic patient-centred focus. The format encourages more conversation and provides the clinician with a better opportunity to ask questions and provide bespoke advice, education and reassurance, while also tackling some of the psychosocial aspects of pain.

“Due to not being able to receive manual therapy in a virtual appointment, many patients recognise that the onus is on them to use the sessions to take control of their own rehabilitation. This approach encourages accountability and can be very motivating for the right patient as they become more engaged in the information and advice they are given.”

However, it notes that virtual sessions might “miss the power of therapeutic touch” and lacked the opportunity for diagnostic tests to take place.

It concludes: “As we eventually move past Covid-19, familiar barriers to in-clinic treatment will re-emerge to front-of-mind, with patients putting off accessing support due to lack of time, family commitments and the inability to travel. It is likely that virtual physiotherapy will become an increasingly attractive option for people in these circumstances.

“The results of this study – potentially the world’s largest study of virtual physiotherapy conducted so far – demonstrate that patients who access digital support to help them with MSK injuries can achieve excellent results.”

The study involved analysing anonymised data of 27,096 patients who had accessed virtual physiotherapy support before and during the Covid-19 crisis and up to 10 June 2020. Of this population, 9,506 had received virtual-only treatment, while 17,590 had received a mix of virtual and face-to-face sessions.

A control group was then built using the data of 6,226 patients who had been treated with in-person physiotherapy only.