The nationwide lockdowns due to the Covid-19 pandemic led to an increase in digital services in outpatient physiotherapy. The Bern University of Applied Sciences, together with other universities of applied sciences, investigated what effects this had on the everyday life of physiotherapists and patients.

The national lockdown in 2020 led to the suspension of “non-urgent” treatments in outpatient physiotherapy. As a result, physical therapy sessions with physical contact decreased by 84 %. This opened the possibility to switch to digital treatment and counselling services. The extent to which physiotherapists implemented the alternatives was the subject of an online survey in the aftermath of the lockdown. A project consortium of the physiotherapy departments of the Bern University of Applied Sciences (BFH), the Zurich University of Applied Sciences (ZHAW), the Haute Ecole de Santé Vaud (HESAV) and the Scuola Universitaria Professionale della Svizzera Italiana (SUPSI) undertook this survey.

A look across the borders

Digital physiotherapy has already established itself in the international context. The World Physiotherapy Association emphasises that digitally mediated physiotherapy can facilitate access to care and health information and make the management of health resources more efficient. Systematic reviews are increasingly demonstrating the effectiveness of real-time tele-rehabilitation contacts for musculoskeletal conditions. Improvements in quality of life, fewer hospitalisations or reduced healthcare utilisation have been observed. In contrast, digital therapy referrals are little known in Switzerland. Possible barriers are the basic self-image of primarily offering “hands-on” therapy and the lack of reimbursement for digital systems or a low affinity for technology within physiotherapy. In addition, digital applications are not practicable because developers often have too little knowledge about physiotherapeutic workflows and treatment processes.

Lockdown as a field of experimentation

During the first lockdown, physiotherapists were only allowed to continue urgently needed therapies or to offer remote therapies. The latter offered an experimental field to gain experience with digital technologies. The online survey on the impact of the lockdown on the use of digital distance physiotherapy took place in summer 2020. It contained more than 700 responses from currently practising physiotherapists throughout Switzerland using the member database of the professional association Physioswiss. Due to the lockdown situation, there was a clear increase in digital distance therapies. Of the respondents, only just under 5% stated that they had used digital distance therapies before the lockdown. During the lockdown, this figure rose to around 45%. Younger therapists (<45 years) and those with little professional experience showed a much higher affinity for digital technologies in the work environment. Remote therapy was mainly (96%) conducted in individual sessions. Some therapists offered both individual and group therapy, although group therapy was only offered by around 10% of respondents.

Areas of application for remote therapy

The most common use of remote digital therapy was for musculoskeletal complaints (68%), which is the most common area of care even under normal conditions. 62 % of the digitally treated patients were members of the Covid 19 risk group. However, therapy at a distance was not only used for training, but also for patient education, for clarifying the progress of therapy, for monitoring compliance with the therapy instructions and for initial contacts with the patients. Most of the consultations took place by telephone, but subsequently messenger services and meeting software with video telephony were also used. In the beginning, there was a lot of confusion about the billing of digital therapy services. Around 30 % billed analogously to individual physiotherapy sessions. 17 % billed via “medical training instructions”. The majority (43%) stated that they had implemented their services without additional billing.

Continuation of digital offers

Half of the respondents stated that the digital communication options had largely compensated for the loss of personal contact. Two-thirds were not convinced that remote treatments could complement regular therapy in the long term. 44% expressed no interest in continuing digital services in the aftermath of the pandemic and considered them more of a temporary phenomenon. In contrast, about 20% of respondents plan to continue using digital therapy as an important element of the service offering in the future. In the second lockdown from December 2020 to February 2021, regulatory improvements had already been implemented by expanding the indications for remote digital therapy and adjusting the tariff positions. The lockdown situation showed that Swiss outpatient physiotherapy reacted quickly and straightforwardly to the changed conditions. In the aftermath, standards for the use of the technologies – especially with regard to aspects of data security – must now be developed. Basically, new concepts are needed to link “presence” and “digital” therapy in a meaningful way. Physiotherapists also need to further develop their eHealth competence. Digital offers similar to foreign models must be given more space in training.

Literature

1. Swiss Federal Statistical Office (2017). Swiss Health Survey 2017. Neuchâtel, Switzerland. https://www.bfs.admin.ch/ bfs/en/home/statistics/health/surveys/sgb.html [accessed 3.11.2021].
2. Rausch, A. K. et al (2021). Physiotherapists’ use and perceptions of digital remote physiotherapy during COVID-19 lockdown in Switzerland: an online cross-sectional survey. In: Arch Physiother. 11(1): 18.

This article appeared in the May 2022 issue of the health magazine “frequenz”. You can subscribe to the magazine of the Department of Health at Bern University of Applied Sciences free of charge and read it online.