When Is Telehealth the Right Choice for Your Patients?

An Overwhelming Need

The COVID-19 pandemic has created an unprecedented need to care for patients remotely. Worldwide, the pandemic continues to accelerate, even as U.S. case numbers show signs of a possible plateau.^1,2 The World Health Organization (WHO) has warned that without a unified national and world response, the worst of the pandemic may be ahead of us.³

Both infectious disease experts and the White House's reopening plan indicate a slow, gradual return to normal,4,5, driving an ongoing intermediate- and long-term need for telehealth as an alternative care delivery model.

Improving Access

Even when things are considered normal, one of the primary benefits of telehealth is improved access to care for patients with various limitations. These limitations might include:

• Transportation challenges

• Socioeconomic barriers

• Long distances between providers and patients

These limitations are particularly amplified in rural areas, especially when patients are seeking specialty providers. Of course, access issues are amplified when shelter-in-place orders are the norm, and once these are lifted for the general public, high-risk populations may still be asked to shelter in place, and social distancing precautions in modified forms may continue for the foreseeable future.^4,5

Choosing Telehealth

At this time, there does not appear to be any consensus guidelines for telerehab precautions or contraindications.⁶ So how can practitioners know when telehealth is an appropriate choice for their patients?

The following list provides examples to help you make informed decisions about whether your patient is a suitable candidate for ongoing care with telerehab.

Indications

• Patients at high risk for severe COVID-19.⁷

• This includes:

  • People with transportation barriers (including distance)

  • Patients who desire and consent to telehealth care

  • Patients with scheduling and time limitations

Precautions

• Does the patient demonstrate a need for an intervention that requires a hands-on technique? If you could accomplish the same goal with therapeutic exercise, your patient may still be a candidate.

• Does the patient have a moderate fall risk that can be managed with in-home safety precautions during treatment?

Contraindications

• Patients with red flag conditions or symptoms that require physical examination, reflex testing, or imaging

• Patients who are medically fragile enough that monitoring of vitals or cardiopulmonary status cannot be safely accomplished remotely

• Patients who are at severe fall risk

• Patients who fail the clinical prediction rule would require imaging. Examples of these include Canadian C-Spine Rules and Ottawa Ankle Rules. If the rule requires palpation, the practitioner may attempt to have the patient self-palpate with video guidance. However, the practitioner should understand the limitations of this approach and thus have a lower threshold for referral, particularly in cases of traumatic onset, which require a physical examination.

• Patient whose cognition limits the ability to participate by video

• Patients whose outcome would be harmed by the lack of a specific physical intervention

Resuming Telehealth

If you need to pause telehealth visits for referral to another provider or for an in-person visit, this does not preclude resumption of telehealth visits when or if these concerns are cleared. Depending on the clinical situation, a blended delivery model of face-to-face visits and telehealth shouldn't be excluded as a viable option as well.

For more information on incorporating telehealth into your practice, please see:

• 4 Tips for Conducting Successful E-Visits

• Engaging Pediatric Clients in a Teletherapy Setting

• Incorporating Telehealth into Home Health Care Part 1: Practical Strategies

• Incorporating Telehealth into Home Health Care Part 2: Reimbursement Status