Hands on the computer, not the patient: Physiotherapists adapt to offer virtual care during pandemic

Physiotherapy is usually considered a hands-on profession, with practitioners manipulating damaged joints and guiding patients through a series of exercises.

But when the Ontario government and their professional college issued orders in March to shutdown all non-essential businesses to prevent the spread of COVID-19, physiotherapists across the province suddenly faced the dilemma of helping someone rehab from an injury when physical distancing rules mean you can't touch the client.

"This is what we do for a living, we try to help people," said Michael Belcamino, a physiotherapist who, along with his colleagues at Walser and Associates in Thunder Bay, found a secure, confidential way to deliver care online. 

Now, through an encrypted network, and as long as the patient has a computer, tablet or smartphone with a camera and email,  Belcamino and other physiotherapists can offer face-to-face care, just not in the same room.

It's "a bit of a misconception" that physiotherapy is only about the hands-on portion of the treatment, he said, noting that taking a thorough history of the injury, observing and assessing someone's movement, and listening to them talk about what causes their pain are equally important.

"Initially it can be a little frustrating because you just want to reach out and say 'what am I feeling here'​​​​​- Michael Belcamino, Thunder Bay physiotherapist

In his virtual appointments, Belcamino demonstrates a series of exercises, asks his client to try them, and then describe whether the pain increases or decreases with the motion.

Once they've settled on the exercises that work, and he is confident that the person is performing them properly, Belcamino tells them how many repetitions to do, and how often. He then writes the prescription, including diagrams of the activity, in an email, which is also encrypted for privacy.

The new virtual system allows physios to "maintain some continuity of care without having to put our hands on the patient."

It also gives people some control over their own rehabilitation, which can often lead to a better outcome.

Helping patients 'treat themselves' 

"If I haven't put my hands on them, and they can get better with what they do, then they can treat themselves, they don't need to be coming here two or three times a week for me to do something," said Belcamino.

Traditionally, diagnosing the injury might involve a more hands-on approach, such as moving a knee joint in a variety of directions to determine if there is a torn ligament or meniscus, but "we've had to morph ourselves into using the virtual platform to do a lot of those hands on assessment techniques."

He said his group is adapting to those scenarios by figuring out what they need to see from the patients, and by sharing best practices between colleagues.

"Initially it can be a little frustrating because you just want to reach out and say 'what am I feeling here' . It's an ongoing learning process and your problem solving skills really start to improve."

Virtual care restores some normalcy to life

Belcamino said the skills he and his colleagues are learning during this pandemic could improve the delivery of physio services to remote communities across northwestern Ontario in the future,explaining he is using the virtual platform to treat patient in Thunder Bay and all along the north shore of Lake Superior. .

"This will help a lot of people," he said. "This will help us open up to a lot of places that did not have the ability to get basic physiotherapy care, all they need is a modem and a linkup and we can communicate with them, not just by phone but virtually"

The ability to still provide care is also helping Belcamino deal with disruption and "sense of loss" he, and almost everyone is feeling due to the changes brought on by COVID-19 pandemic.

Those first few weeks of the social lockdown, Belcamino said he felt a "sense of loss" at not being able to do a job he'd been working at for over 25 years.

"Oh my goodness, all I know how to do and you've taken that away from me," he said. "This ability to come back and do even 75 or 80 per cent of what I was doing before brings back some of that fulfilment.

You can hear the full interview with Michael Belcamino on CBC's Superior Morning here.