The COVID-19 pandemic brought telehealth-based care to the forefront in many health professions in the early part of 2020. For example, an APTA survey showed that only 2% of respondents had offered telehealth services prior to the pandemic, but by 2021, that number had reached almost 50%.1 In addition, the number of published articles for a PubMed search with the terms "telerehabilitation and physical therapy" more than doubled from 2019 to 2021. Since then, legislation supporting telehealth care, including for Medicare beneficiaries, has expanded rapidly and investors have sunk tens of billions of dollars into new companies providing remote care for a range of conditions from behavioral health to chronic disease management to musculoskeletal care. Over the prior decade, a reasonable body of research supporting the effectiveness of telehealth physical therapy interventions for musculoskeletal conditions has been amassed. However, despite the range of populations such as those with cardiovascular conditions, neurologic conditions, and developmental conditions who could benefit from telehealth physical therapy, little has been investigated about telehealth physical therapy in the geriatric population or diagnoses beyond those of musculoskeletal origin.2-4

Physical therapists (PTs) have cited the following reasons as barriers to providing care via telehealth:

* Difficulty observing the patient via telehealth, which may hinder the ability to evaluate the patient performing exercises or their ability to assess movement;

* Difficulty performing specific tests and measures;

* Concerns with privacy when conducting telehealth visits;

* Concerns with limitations in technology including the patient's technological proficiency and limitations in the patient's devices and/or network connection; and

* Challenges in how the telehealth software integrates with other software they utilize while providing care such as electronic health record (EHR) or home exercise program applications.5

Recent APTA research indicates that individuals highlight the following reasons for not seeking telehealth care:

* They believe the quality of care would be lower.

* They would not have access to hands-on therapy and guidance PTs provide.

* They would not have access to specific exercise equipment.6

Other investigators have shown that patients report the following reasons for preferring in-person care:

* Would not have the same level of intimacy established between them and their PT.7

* Not wanting to use a computer.8

Despite the number of limitations highlighted by patients, those who have received telehealth also have some tips for therapists to enhance the telehealth care experience. These include the following:

* Evaluate the whole patient, not just the area of concern.

* Make a strong effort to connect with patients and ensure the patients are heard.

* Be empathetic and show your patients you care, even if not providing care face to face.

* Be attentive with listening skills and your nonverbal communications.5

There is also a prevailing perception that older adults are not tech-savvy and therefore are unlikely to be interested in receiving health care over the Internet. However, 61% of US adults older than 65 years own a smartphone and 41% own a tablet as of 2021 according to Pew Research.9 Sixty-four percent of that population has a broadband Internet connection in their home, which, in combination with a mobile device, would allow them to access and utilize telehealth physical therapy, including synchronous video visits and many services provided via mobile apps.9 Furthermore, prior research has demonstrated adoption across generations and high satisfaction among the geriatric population when receiving care via telehealth. Numerous benefits of utilizing telehealth have been demonstrated in older populations including allowing therapist to see the home environment, reduced travel time, and convenience of scheduling with caregivers.

This issue presents research focused on the geriatric population demonstrating the feasibility of common outcome measures, successful implementation of balance training programs, as well as discussing the challenges and benefits of telehealth for many stakeholders: patients, caregivers, and providers. As always, research is a constant evolution, and our hope is that the research presented here will provide practical guidance for your practice as the body of telehealth research expands and continues to provide greater clarity on best practices when delivering physical therapy via telehealth for a geriatric population.

-Todd Norwood, DPT

Issue Editor

References