Telehealth — virtual visits with a health care provider — was on a slow rise prior to the COVID-19 pandemic. But lockdowns and social distancing drastically increased the need for patients to receive care from medical professionals remotely. This includes occupational therapists, who are essential care providers for some arthritis patients who can benefit from sessions to help improve function during daily activities. This includes everything from lifting heavy objects to closing buttons to chopping vegetables.
People with arthritis can utilize occupational therapy when limitations from their condition — such as weak wrists or lower back pain — prevent them from performing their job, exercises, community activities, hobbies, and household chores. Occupational therapists (OTs) help people with arthritis overcome these obstacles by teaching new ways to perform tasks, offering tips to reduce stiffness and pain, and strengthening muscles surrounding damaged joints through targeted exercises.
Although you may think that occupational therapy for arthritis needs to be done in person and face to face, it turns out that much of this education can be provided via teleconferencing tools like Zoom, FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype. In fact, doing an occupational therapy session via telehealth may provide a better experience for the patient.
“It’s a great value to see someone interact in their home with the instructions you gave them. Interacting in clinics is sterile,” said Tammy Richmond, CEO and Founder of Go 2 Care, an occupational therapy practice in Los Angeles that uses telehealth extensively. This may allow your therapist to better tailor their recommendations for your unique home environment.
But before switching to virtual occupational therapy appointments or trying it out for the first time, it’s important to know what to expect and how to make the most of it. Read more about virtual occupational therapy, including how sessions can be different from in-person visits and how to prepare for them.
Types of Telehealth Occupational Therapy
In the spring of 2020 as a response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) announced that it would broaden access to Medicare telehealth services by relaxing some privacy rules, eliminating restrictions on out-of-state care, providing similar financial coverage for telehealth visits as in-person appointments, and expanding the types of practitioners (including OTs) who would qualify for reimbursement. Most private insurers followed suit.
According to the American Journal of Occupational Therapy, CMS reimburses the two main types of telemedicine: synchronous (taking place in real time, as in a FaceTime meeting) and asynchronous (forwarding of information, such as a video of how to modify an activity to make it more arthritis-friendly, without real-time communication). By far the most common form of contact with occupational therapists is synchronous.
Synchronous virtual visits are very similar to in-person OT sessions. Over a digital screen (phone, tablet, or computer), an OT will ask how you are doing, find out where you need help, and focus the session on helping you deal with your limitations. One big difference between telehealth and in-person occupational therapy sessions is that the therapist may ask for a family member or caretaker to be present to help with taking measurements or explaining your environment.
Benefits of Telehealth Occupational Therapy
During the COVID-19 pandemic, the most obvious benefit of telehealth sessions was reducing a patient’s risk of contracting the coronavirus by reducing their exposure. This is especially important for people with arthritis and inflammatory conditions who have issues with immune system function and may take medications that weaken their immune system, potentially increasing their vulnerability to COVID-19.
But there are other benefits to telehealth occupational therapy for people with arthritis that aren’t related to the pandemic. These include:
- Convenience: You can save time, plus the cost of gas, parking, or public transportation fares, by not traveling to a practitioner’s office.
- Access: Arthritis patients who live in rural areas may not have as many options for seeing occupational therapists in person. People who are coping with chronic pain and fatigue may have challenges getting to and from in-person visits.
- More personalized care: According to a February 2021 article published in the journal JAMA, “the stunning, pandemic-related expansion of virtual care has also had the unexpected consequence of offering clinicians humbling insights into the lives of patients.” In other words, by seeing patients in their home and work environments, occupational therapist can better tailor their advice for patients. For instance, seeing a kitchen crammed with pots, pans, cutting boards, knives, and cookbooks demonstrates to your OT how essential cooking is to your life. As a result, they may shift their sessions to focus on making cooking easier.
- More caregiver involvement: According to a 2021 study published in the International Journal of Telerehabilitation, if a caregiver attends your sessions, they tend to become more engaged in the process, which may make it easier for them to help patients follow a home exercise program.
Obstacles with Telehealth Occupational Therapy
A main challenge with telehealth occupational therapy is technology. Some patients, especially those who live in rural areas and are older, might not have access to the electronic devices, WiFi, or connectivity needed to support teleconferencing apps. There are also the inevitable glitches that happen during virtual meetings, which can interrupt the flow of the session. Privacy can also be a concern, as an arthritis patient who lives with other people may have difficulty finding a spot where he or she can talk without being overheard or interrupted.
Additionally, some features of an occupational therapy session don’t translate as well to a remote session. These include:
- “Reading” a patient. Many OTs “read” a person with arthritis by touching their pain spots, which is not possible during a virtual visit. Additionally, it is more challenging to get accurate measurements of range of motion.
- Massage cannot be done via telehealth.
- Custom splints. This common therapeutic practice isn’t possible without the OT being able to mold the support on a patient’s hand or wrist.
- Ultrasounds. Some therapists use ultrasound therapy during OT sessions to help relieve pain and promote healing.
The Hybrid Option for Telehealth Occupational Therapy
As the pandemic evolves, many health care providers hope to keep telehealth as a treatment option, including OTs. In a small survey published in the International Journal of Telerehabilitation, 77 percent of occupational therapists said they would like to keep using telehealth in some capacity. This may mean adopting a hybrid model, in which early sessions that require hands-on treatment take place in person, but later sessions done for maintenance can be done virtually.
How to Have a Successful Telehealth Session with Your Occupational Therapist
- Find the right spot for a virtual meeting. You need a quiet place so you and the OT can hear each other and focus, as well as privacy, so no one else interrupts your conversation, says Aditi U. Joshi, MD, Medical Director of JeffConnect Telehealth at Thomas Jefferson University in Philadelphia. You also want to find a space that gives you enough room to move. There should be at least six feet of free space around your chair to allow you to exercise and move around safely, says Richmond.
- Test your equipment. Log onto the meeting site five minutes before the appointment so you can check the WiFi, audio, and video connections. Additionally, you want to make sure your device has enough power to last throughout the session. Make sure you have a charger handy in case you need to plug in your device.
- Get ready for your close-up. If possible, put a light next to, or behind, your screen. You’ll create shadows if there is a light source behind you, which could impact your therapist’s ability to see you well. You also want to make sure your web camera is hitting you at eye level. Otherwise, the OT may only see part of your face.
- Write down ahead of time what you want to focus on. The structure of your session will be dictated by what problems you are experiencing now. The meeting will operate more efficiently if you have already made notes about your concerns.
- Consider whether or not you want a caregiver or family member to be present. A second person can help with measurements and with remembering suggestions. They can also help with positioning the camera for certain tasks to give the OT a better view.
- Bring a bag with all your medications. Medications can affect your fatigue level, and it is helpful for the OT to know exactly what you’re taking.
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Dahl-popolizio S, et al. Telehealth for the Provision of Occupational Therapy: Reflections on Experiences During the COVID-19 Pandemic. International Journal of Telerehabilitation. December 8, 2020. doi: https://doi.org/10.5195/ijt.2020.6328.
Interview with Aditi U. Joshi, MD, Medical Director of JeffConnect Telehealth, Thomas Jefferson University, Philadelphia, PA
Interview with Tammy Richmond, CEO and founder of Go 2 Care (occupational therapy with an emphasis on telehealth), Los Angeles, CA
Medicare Telemedicine Health Care Provider Fact Sheet. Centers for Medicare & Medicaid Services. March 17, 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
Telehealth in Occupational Therapy. The American Journal of Occupational Therapy. December 2018. doi: https://doi.org/10.5014/ajot.2018.72S219.
Zulman DM, et al. Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19: Unforeseen Opportunity in the Face of Adversity. JAMA. February 2, 2021. doi: https://doi.org/10.1001/jama.2020.27304.