Telephysiotherapy: time to get online

The science and practice of telehealth have undergone rapid growth in recent years.A search of the Web of Science for the term 'telehealth' would have returned only two papers in 1995, compared with 104 papers in 2000, and 5069 papers in June 2017.This exponential growth is also evident in the number of randomised, controlled trials and systematic reviews indexed in the Physiotherapy Evidence Database with 'telehealth' in the title, rising from 10 records in 2008 to 70 records in 2017.These papers span the breadth of physiotherapy practice, with particularly strong representation from musculoskeletal and cardiorespiratory physiotherapy (Figure 1).High-quality randomised, controlled trials that support the benefits of telehealth interventions in many physiotherapy subdisciplines have been published over recent years.These have included telephysiotherapy interventions for chronic knee pain, 1 non-specific low back pain, 2 chronic obstructive pulmonary disease (COPD), 3 heart disease, 4 breast cancer, 5 joint arthroplasty, 6 and urinary incontinence.7 Many of these studies have demonstrated significantly better clinical outcomes than usual care that did not include physiotherapy, including improved exercise capacity, better physical function, reduced symptoms and enhanced health-related quality of life.Telephysiotherapy can take many different forms, with the components driven by the goals of treatment.Videoconferencing provides direct contact between patients and physiotherapists, either one-to-one 1 or in a virtual group setting.3 For some telephysiotherapy programs (eg, pulmonary rehabilitation, stroke rehabilitation) it may be necessary to perform a limited number of home visits, in order to perform assessments or provide instruction in the use of equipment.3,8 However, some telephysiotherapy programs are delivered entirely from a distance, without ever meeting the patient in person, including notable examples of successful treatment of stress urinary incontinence using email support 7 and a mobile app. 9 Telephysiotherapy programs may include remote monitoring of physiological signals, such as pulse rate, oxygen saturation, electrocardiograms (ECG), and joint range of movement, in specific populations such as cardiorespiratory or orthopaedic disease.4,10,11 Whilst some telephysiotherapy models require specially designed equipment, 6,11 others have achieved similarly successful outcomes with off-the-shelf consumer devices and software.1,3 The ubiquitous nature of the smartphone provides new opportunities for telephysiotherapy, including: physical activity monitoring; sound and light cues to set exercise intensity and duration; real-time feedback on exercise performance; and text messaging to provide exercise advice or progression.10,12 Simple web-based diaries can be used to record exercise and provide feedback.12 Didactic or interactive education programs can also be provided.1 In some populations it may be possible to automate aspects of a telephysiotherapy program to provide efficient and effective care to large patient populations, for Journal of Physiotherapy 63 (2017) 193-195