A New Dimension of Partnership: A Physical Therapist's Perspective on Telehealth During COVID-19
Just a few intense weeks after canceling my entire caseload of patients due to COVID-19, I sat down in front of my computer to begin my first telehealth appointment. As a physical therapist, I was ready to start rebuilding relationships with my patients — but also a little daunted — by the challenges of delivering physical therapy without physical interaction. I sensed a similar mixture of excitement and concern in my patients as we began our initial video visit; they seemed appreciative to regain access to care as well as apprehensive to adapt yet another area of their life in response to the pandemic. An unexpected result of pushing through these challenges together has been a new dimension of partnership with my patients.
Mr. Adams was one of the first patients I met, evaluated, and treated over video. From the beginning, I noticed a sense of achievement and ownership, evident after he successfully navigated the software and initiated the video visit. He seemed empowered as he (virtually) invited me into his space. After some fumbling with the camera angles and microphone volume, I learned that Mr. Adams had radiating pain from his back down to his foot which limited his function in many ways, including the ability to sit, walk, and bend down to put on his socks. Early on we made one of our goals to improve his hip flexion mobility. In person, I could easily measure the impact of an intervention on the range and quality of motion through coupling his subjective experience with a hands-on assessment of hip flexion mobility before and after I performed a manual mobilization technique. Over video, we do this together. I ask him to reach down to his foot and describe how it feels, perform a stretch himself, then reach back down to his foot and relate any changes, or lack thereof, he notices. I offer direction and insight as the session continues, but Mr. Adams does the work of healing with his own hands and feet. It’s rewarding to watch how his active role in the progression of the treatment further builds his self-efficacy.
At the beginning of the pandemic, figuring out the most effective ways to treat my patients over video was just one of my concerns. I was challenged to keep the effects of the uncertainty, danger, and loss we are experiencing in mind as I practice, to remember that the confusion and limitations of Mr. Adams’ leg pain are magnified when the whole world seems confusing and limiting. His feelings of uneasiness and frustration resonated with similar feelings of my own, coming in part from the boundaries I feel professionally. My “normal routine” has also had to change significantly, and there’s no clear end in sight. Yes, we’re finding good in the virtual format, but I’m aware of losing the precision of interventions that come with hands-on care, the trust that is built through face to face conversations and the confidence to make recommendations such as “take a walk in the neighborhood” without the fear that I’m endangering someone’s life. As the pandemic evolves, I’ve been intrigued by the idea that this shared experience of uncertainty and loss has connected us in a way we didn’t have before — perhaps allowing for a small shift in the relationship between patient and provider.
For our second visit, I had prepared a series of exercises to address the impairments that limited Mr. Adams’ ability to walk. Yet as we talked more about his daily routines, I realized that his walking was significantly affected not only by his leg pain but also by fear of going outside, confusion over if he even should, and grief over the loss of his social and volunteer opportunities. Since the success of any visit relies on partnership, it’s essential that each person feels safe to test their limits and to explore new ways of relating to movement even without the physical presence of their healthcare provider. I decided to loosen my grasp on my plan for a “normal” treatment session and only teach a few of my exercises to make space to listen to and honor these pieces of Mr. Adams’ walking experience. Over the following weeks, Mr. Adams and I have continued to exercise and talk together, and his world has slowly become less limited. He now puts on socks without a second thought and is back to walking his accustomed 2-3 miles a day.
We’ve all learned more about ourselves during the upheaval of COVID-19. Mr. Adams has learned how and why to perform the movements that manage his symptoms and facilitate his healing. As his physical therapist, I’ve discovered a little more about what a successful patient-provider partnership looks like today. I do think that video visits have allowed for interactions that are uniquely suited to this time — not only increasing access to the health services that people need, but also providing opportunities to partner with each other as we walk through this unusual time. As we return to in-person care, I’ll bring with me the ways I built connection and camaraderie with patients like Mr. Adams into my practice.