Hands off: Nova Scotia physiotherapists learn to make adjustment to virtual care

Physical distancing and self-isolation pose a distinct challenge for physiotherapists, whose job title literally refers to making physical contact with patients.

But physiotherapists in Nova Scotia are finding ways to modify their practices and provide virtual care during the COVID-19 pandemic.

Out of 180 private physiotherapy clinics listed by the Nova Scotia College of Physiotherapists, 99 are now providing phone or video treatment options.

Stephen Richey, president of the Nova Scotia Physiotherapists Association, said the regulatory authority to provide virtual care was already in place, but wasn't commonly used in Nova Scotia until recently.

In the past two weeks, Richey said virtual means have become the primary mode of delivering physiotherapy.

"I think anybody that's been to physio in the past knows that there's a big hands-on component .... So it's certainly an interesting change," said Richey in an interview.

Treatment through education

Nova Scotia declared a state of emergency on March 22, ordering people to stay two metres from each other and forcing the stoppage of many non-urgent medical services.

Under those provincial orders, which were recently extended to at least Apr. 19, private-practice physiotherapists can still meet face-to-face with patients for urgent and emergency care. But for all other cases, they have to use virtual means.

By phone or video, and with the help of email, physiotherapists can monitor ongoing concerns, offer advice and coach patients through exercises, according to Richey.

"Physios, I think, recognize that one of the biggest impacts we usually try to have with patients is through education and guidance with exercise programs. So that's something that actually transfers quite well to telehealth," he said.

Richey said his association which represents about 550 out of more than 700 physiotherapists in Nova Scotia is learning from other Canadian physiotherapists who have well-established virtual practices. Most of them, he said, are in remote, often Northern, communities.

Virtual-care insurance coverage

The biggest obstacle in the move to virtual care, according to Richey, was insurance coverage. He said most bills for private physiotherapy treatment are paid for, at least in part, through patients' extended health benefits.

In the past two weeks, Richey said his association and counterparts across the country have established agreements with most major health insurers including Blue Cross, Manulife, Chamber of Commerce, Canada Lifeand Sunlife to cover telehealth services as they would for regular in-person visits.

Physiotherapists in the public sector are also adjusting to the pandemic.

Fraser Mooney, a spokesperson for the Nova Scotia Health Authority, said the focus for physiotherapists in hospitals has shifted "almost completely" to discharging patients to make room for an expected surge related to COVID-19.

Public clinics with outpatient physiotherapy services have curtailed appointments, are meeting with patients by phone and video whenever possibleand are only accepting urgent referrals, Mooney said.

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