A.M Ezzat1,2, J.-F. Esculier2,3, S. Wong4,5
1La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Melbourne, Australia, 2University of British Columbia, Department of Physical Therapy, Vancouver, Canada, 3The Running Clinic, Lac Beauport, Canada, 4University of British Columbia, School of Nursing, Vancouver, Canada, 5University of British Columbia, Centre for Health Services and Policy Research, Vancouver, Canada
Background: COVID-19 forced the rapid adaptation of health care delivery on a global scale. Contributing to the containment of COVID-19, many physiotherapy practices across Canada closed to in-person care resulting in a huge disruption in preventative and rehabilitative care for Canadians. Physiotherapists turned to virtual care to continue to provide services during COVID-19.
Purpose: To describe the extent to which Canadian physiotherapists implemented virtual care as a service delivery model during early phase of COVID-19 pandemic. Secondarily, to explore physiotherapists’ perceptions on the advantages and disadvantages of virtual care and what is needed for ongoing implementation and provision of virtual care.
Methods: Beginning in mid-May 2020, a short bi-weekly 3-minute survey was sent out via an anonymous link using the University of British Columbia Survey Tool (Qualtrics). It was disseminated through certain branches (e.g. Physiotherapy Association of British Columbia) and Divisions (e.g. Orthopaedic Division) of the Canadian Physiotherapy Association, social media, and personal networks. There were 4 survey cycles, each remaining open for 4 days. Descriptive statistics (frequency, percentage) summarized the main findings. Open ended questions were analysed thematically using a framework approach.
Results: In cycle 1, 1,972 Canadian physiotherapists responded, with every province and one territory represented. The majority (76%) reported working in private practice with 30% being clinic owners. Nearly a quarter (24%) reported working in a rural setting, 16% worked in a hospital, and 27% reported that over half of their patients spoke a language other than English or French as their first language. While sample size decreased in subsequent cycles (cycle 2: n=1245; cycle 3: n=554; cycle 4: n=426), practice characteristics were proportionally similar. In cycle 1, 79% of physiotherapists who had stopping or modified their delivery of in-person care were providing virtual physiotherapy services. In subsequent cycles, as in-person care increased, virtual care was provided by 74%, 71%, and 62% physiotherapists in cycles 2-4, respectively. Physiotherapists stated advantages of virtual care included allowing continuity of care during COVID-19 and in other circumstances where patients would be unable to access in-person care (i.e. remote location); promoting patient independence and self-management; and strengthening physiotherapists’ communication and exercise prescription skills. Disadvantages included: inability to assess and treat ‘hands-on,’ challenging to build patient rapport/trust, and some patients lack technology access or skills. For ongoing implementation and provision of virtual care, physiotherapists stated they needed: resources providing practical strategies for virtual assessment and treatment; greater advocacy and positive messaging on virtual care directed to the public, government, and insurers; guidance from governing bodies and research evidence to support best practice in virtual care; and further technology and administrative support.
Conclusion(s): Canadian physiotherapists showed high levels of adaptability through their widespread, rapid implementation of virtual care during the pandemic. Many physiotherapists embraced virtual care as part of a hybrid model of practice, although recognizing its limitations for some patients and conditions.
Implications: Virtual care has emerged as a viable service delivery model for physiotherapists during COVID-19 and beyond. Physiotherapists articulated specific areas of support from governments and health leaders required for ongoing successful provision of virtual care.
Funding, acknowledgements: This study was supported by the British Columbia Primary Health Care Research Network.
Keywords: Virtual care, survey
Topic: COVID-19
Did this work require ethics approval? Yes
Institution: University of British Columbia
Committee: Behavioural Research Ethics Board
Ethics number: H20-01434
All authors, affiliations and abstracts have been published as submitted.
