Telehealth Versus In-person Musculoskeletal Physiotherapy Assessment: A Comparison of Specific Outcomes

Published Date: 21st June 2024

Publication Authors: Hallinan. D

Aim
To test the hypothesis that MSK physiotherapy assessment through telehealth results in different outcomes relative to in-person assessment.

Methods
*This is a retrospective evaluation of two large sample groups of patients assessed within an NHS MSK service by senior and advanced practitioner physiotherapists.* To represent in-person physiotherapy assessments, 3 months of pre-pandemic data from October - December 2019, containing 100% of the in-person assessments was analysed. * To represent telehealth activity, 3 months of intra-pandemic data from October - December 2020 was analysed. This sample contained 100% of the telehealth assessments during this period.

Results
There were 4,008 patients in the in-person sample, and 2,966 in the telehealth sample. OBJECTIVE 1: the rate of MRI requesting was 3.5% higher in the telehealth sample. There was less than a 1.1% difference with the rate of all other investigations, demonstrating excellent consistency. OBJECTIVE 2: despite the pandemic and a smaller sample size, the amount of significant pathology findings was 600% higher within the telehealth sample. This suggests a higher rate of patients with urgent needs were filtering through primary care services into secondary MSK services during the pandemic. OBJECTIVE 3: the provision of advice, education, and rehabilitation programmes to patients was similar between both samples. In the telehealth group, the provision of rehabilitation programmes was only 3.3% less, while the rate of advice and education provision rose 6.2%. OBJECTIVE 4: escalation of a patient to a senior clinician for the first follow-up after assessment was 14.8% higher in the telehealth group. This result is likely biased, as in-person follow-up clinics in this MSK service were mostly staffed (during pandemic lockdown periods) by either MSK Doctors or Advanced Practitioner Physiotherapists. OBJECTIVE 5: the frequency of soft tissue injury diagnosis was consistent between both samples. Less than 5% of the in-person sample, and less than 1% of the telehealth sample had a corticosteroid injection follow-up booked after assessment. This reduction in the telehealth sample can be explained by initial fears that existed around the potential immunosuppressant effect of steroid injections during the COVID-19 pandemic.

Conclusion(s)
Most results exhibited statistically significant differences between the two samples, and there are some particularly notable outcomes. Some differences may be due to the alternate path to diagnosis and management, i.e. telehealth versus in-person. However, some are likely to be a by-product of the impact of the pandemic on the telehealth sample, rather than inherent differences between the telehealth vs in-person groups. For example, GP referral patterns will have additional biases due to the overarching situation of an ongoing pandemic; it is also possible a portion of the general public self-selected out of the telehealth sample as they did not want to stress the health system unduly during a pandemic. Impact: To our knowledge, this is the first study investigating if stakeholders can expect the same consistency in service from MSK outpatient physiotherapy assessment, whether via telehealth or in-person.

 

Hallinan, D. (2024). Telehealth Versus In-person Musculoskeletal Physiotherapy Assessment: A Comparison of Specific Outcomes. Physiotherapy. 123(Suppl. 1), pp.E91-E92. [Online]. Available at: https://doi.org/10.1016/j.physio.2024.04.111 [Accessed 28 June 2024]

 

« Back