There has been a gentle fascination regarding the use of telehealth for physical therapy services for the last few years. This change was accelerated and necessary for survival with the onset of the COVID-19 pandemic. I understand that the ability to see patients remotely helped to keep many outpatient practices above water, or at least able to tread water until things transitioned back to a semi-normal routine. Since then there has been this giant push to make telehealth a permanent part of physical therapy practice, but has anyone stopped to ask if this is good for our profession in the long run?
During my interview for PT school I was asked, is physical therapy science, or art? Of course my answer was some of both. The technical part of the job is science based, but the ability to interact with patients through words, body language and palpation has that touchy, feely, artful component. Dave Nicholls with the Critical Physiotherapy Network wrote a blog pondering this same question, is physiotherapy a technical craft or an art practice? He noted that “With technical craft skill being one of the central locations for innovations in new technology, it is likely that many of the old skills of the physiotherapists will be picked up either by people who are much less expensive to train than us, or machines” (1). If that is the case, what is left for the PT to do?
If we decide that we can function without being physically present with our patients, we give up the “art” component of our profession. Then it is only a matter of time before we will become obsolete. Some will argue that we are experts in movement and patients need that expertise. Well here’s some bad news, there are artificial intelligence programs that can analyze movement just as well as we can, or better, and make recommendations for activity modification, corrective exercises, and pain management strategies.
With the use of hi-def video and wearable sensors, patients can collect their own data and use AI to get recommendations and feedback on performance and progress. All of this technology exists currently and is becoming increasingly available to the public. Why pay us to watch and analyze their movement and correct their exercise when a computer can do the same thing for free and at their convenience.
Michael Rowe from the Department of Physiotherapy at University of the Western Cape opined on the impact of AI on physical therapy clinical practice and made this point, “if the nature of future practice is such that the technical components of the discipline (PT) are outsourced to intelligent machines, we may find ourselves in the position of being well-trained, competent, and irrelevant.” (2)
There is no doubt regarding the benefit of physical contact in patient care, but we seem to be blindly jumping into a system of providing care that robs the patient of that component of physical therapy. One of the things I love about being a PT is that I have developed manual skills over a 23-year career that can result in meaningful and immediate change for my patients. There have been many times in my life where I saw a patient for one visit and they reported after treatment that they hadn’t felt or functioned this well in weeks, months and on occasion, years.
So the question remains, are we a profession that can function without being physically present with our patient? If the answer is yes, then PT as it’s currently structured won’t survive. Are we just pushing for telehealth access because we want so badly to be thought of on the same level as primary care providers? If it’s good for them, then it must be good for us too. I think it’s long overdue we stop and think about the consequences to our profession before adopting the position that telehealth is the solution to our current woes.
If we continue to push for the ability to provide physical therapy via telehealth and bypass the need to be hands-on with our patients, we might be choosing to make ourselves and our profession irrelevant in the near future. Soon enough artificial intelligence will take over a large part of what we do, let’s not give the rest away too easily.
References
- Nicholls, D. (2018, September 5). What’s the difference between a technician and an artist?. Critical Physiotherapy Network. https://criticalphysio.net/2018/05/09/whats-the-difference-between-a-technician-and-an-artist/
- Rowe, M. (2019, August 23). Artificial intelligence in clinical practice: Implications for physiotherapy education. OpenPhysio. https://www.openphysiojournal.com/article/artificial-intelligence-in-clinical-practice-implications-for-physiotherapy-education/