COVID-19: Physical Therapists and Patients Adjust to Telehealth

(Courtesy Penn Partners)

Since the COVID-19 pandemic struck in mid-March, physical therapists, like other health care workers, haven’t been able to catch a break. Because they’re considered essential workers, many have had to go into work and treat patients just as they would pre-pandemic. 

Therapists abide by stringent protocols which include wearing masks at all times, having a maximum number of clients inside a clinic at once, constantly cleaning supplies and equipment, and instituting more telehealth options for certain clients. 

“Everybody’s masked in a surgical mask,” Niko Kuperman, a physical therapist at Good Shepherd Penn Partners, said. “That’s all day, every day, unless you’re in a room by yourself or eating lunch, which is socially distanced. We have to wear gloves anytime we’re touching any patients and we have to wear safety goggles during any patient care.” 

For some, the workload has stayed the same or even increased. 

“My job really hasn’t changed that much in terms of the care that I provide,” Chris Carroll, a physical therapist at Magee Rehabilitation Center, said. “I’m still very hands-on with patients, very much physically in close contact with patients. My caseload has only gotten more heavy with COVID-19 ‘cause there’s a lot of complications, like strokes and things like that, that COVID-19 causes.”

Carroll works at a neurological rehab center at Magee, which is under the Jefferson Health umbrella. He primarily deals with spinal cord injuries, brain injuries, and stroke patients. 

Carroll and his co-workers continue to perform every physical therapy session in person, as all of their patients are in some form of recovery in the hospital. 

“Jefferson Health took a very strategic approach in terms of how they decided to handle the situation,” Carroll said. “We were lucky and supported with lots of PPE.” 

Access to personal protection equipment (PPE) has helped Carroll feel safer while at work.

“We’ve been provided with the necessary equipment to make sure we’re safe, which is good,” he said. “But it’s also pretty intense and pretty heavy duty in terms of trying to take all that in while still going to work every day.”

Penn Medicine, the umbrella provider Kuperman works for, is currently offering both in-person and telehealth appointments. 

“There were always people coming into the clinic that were deemed necessary,” Kuperman said. “If somebody had just had a total knee reconstruction on March 13, they needed to come into therapy. Compared to somebody who’s just been having three years of chronic low back pain, they probably don’t need to come in and that’s not an emergency.”

The space inside Kuperman’s clinic is divided into hubs based on clients’ different needs. Some physicians meet with clients in-person, others offer telehealth sessions using the BlueJeans video conferencing app

Kuperman was one of three orthopedic clinicians from the physical therapy department assigned primarily to telehealth duty in the spring.

“We’d come into the office, but we only did telehealth for around six weeks, beginning on April 1 through mid-to-late May,” Kuperman said. “I think it was probably six weeks or so. We kinda helped to develop and build the telehealth caseload, which involves calling people we had seen before and doing new patient evaluations. Just getting that all up and running.”

While Kuperman did enjoy some of the smaller perks of working telehealth — mainly the shorter hours and more open parking spaces at the clinic — it’s not the ideal experience for both the therapist and patient, he said. 

“From the actual physical therapy standpoint, it’s hard to do remotely,” Kuperman said. “It’s hard to get to be a good physical therapist. You have to get people to trust you. You have to get people to buy in. They have to believe what you’re saying, and that’s harder to do remotely.” 

Paying attention to the patient’s body and movements is an important part of the appointment for clinicians, as is communicating to them about what you see, Kuperman said. That observation and communication is much harder to do virtually.

“I think physical therapy is a profession that self-selects for people who are more intuitive to body language and more intuitive to picking up on those little things that maybe you don’t see over the computer or over the phone,” Kuperman said. 

Patient volume also decreased in the early days of the pandemic at Kuperman’s clinic.

“There were some days I would go in and see one person,” Kuperman said. “So that can be kinda demoralizing, in a way.”

Telehealth has also been an adjustment for patients. Susan Behson currently receives treatment for what she called “bouts of unbearable vertigo” at Somerset Hills Physical Therapy in Basking Ridge, New Jersey.

Though she said her experience with telehealth has been “not an optimal one,” she still regularly FaceTimes with her therapists as her husband helps to walk her through the necessary exercises and maneuvers. 

“Normally, I would go in and they’d put me in a private room and go through the procedure that they do,” she said. “Then, when COVID hit, they were closed for some time. And then, because of my health condition, they just wanted to see me virtually.”

For Daniel Friedman-Brown, a junior at the University of Maryland rehabbing a torn ACL, telehealth has been manageable, but he would’ve still preferred in-person visits. 

Friedman-Brown tore his ACL last November and got surgery just before Christmas. Once COVID-19 began to shut down businesses everywhere, he moved to Zoom sessions with his therapists from March until May.

“I sorta got lucky in the timing,” Friedman-Brown said. “With where I was in my rehab, I was pretty much just doing regular lifting and stretching exercises rather than my knee being worked on itself. But if it had happened any later, I don’t think I would’ve been able to get surgery, which I got very quick.” 

Friedman-Brown was a client at Professional Physical Therapy in West Orange, New Jersey prior to the pandemic, but switched to Myokinetix Physical Therapy and Performance in Roseland, New Jersey over the summer, once state restrictions were more relaxed. 

While wearing a mask, a Myokinetix client works to rehab a torn ACL. (Courtesy Myokinetix)

Now back in school, he currently receives treatment at Impact Sports Physical Therapy in Hanover, Maryland. 

Receiving at least some in-person physical therapy shortly after his surgery helped Friedman-Brown start his treatment course with a sense of motivation. 

“I was basically immobile for that first month in December,” he said. “I was just lying on the couch doing nothing. So if I had to start physical therapy at home from the jump, if I had to just sort of start working out where I was lying, I don’t know if I could have done it. It would’ve been hard for me to keep a good schedule and to get motivated to do it.”

As more clinics reopen and more patients are allowed inside for in-person visits and evaluations, telehealth appointments are starting to be phased out. 

Kuperman and his co-workers are seeing more in-person clients, almost as many as before the pandemic, though sessions are still one-on-one and masked.  

Friedman-Brown feels telehealth will stick around, but it has to be used on a case-by-case basis and isn’t for everyone. 

“It’s significantly easier for younger people,” Friedman-Brown said. “But it’s an unfair system to those that are older, who might be 60-65 and up, that need to adjust telehealth.”

Editor’s note: Our special reporting on COVID-19 may focus on communities outside Philadelphia because many of our student journalists are now temporarily located outside of the city. Instead, our reporters will cover how the coronavirus is impacting their own communities from across the country and around the world. We will return to hyperlocal coverage of Philadelphia’s neighborhoods as soon as possible.

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