COVID gave a Boost to Telehealth Services for Rehabilitation Therapy, But Barriers Remain to Widespread Use

Though the COVID pandemic has largely subsided, its effects still remain.  

Social distancing during the pandemic changed society. Most notably, a substantial number of people work from home now. This has resulted in a shift in how people’s work life and businesses, including healthcare providers, operate. Essentially, life has not fully returned to what many of us would have considered “normal” before the pandemic.  

Healthcare providers were greatly affected during and after COVID. During the pandemic, the shift was from in-office visits to telehealth/telemedicine (TH), which refers to electronic communication such as email, and virtual care (VC) such as video visits.  

Though telehealth was available before the pandemic, not many rehabilitation medicine providers offered it as an alternative to an in-person appointment. The pandemic pushed a wider variety of providers into adapting telehealth/virtual care in order to continue patient treatment. With that push, the infrastructure is now in place for rehabilitation providers to practice using telehealth and virtual care.  

But do healthcare providers and patients actually like this? A team of researchers led by Mindi Manes, PhD, of Brooks Rehabilitation, set out to answer this question. 

The Brooks team accomplished this by sending surveys to both rehabilitation providers and patients. The results, which were based on the responses of 441 patients (158 of whom utilized telehealth/virtual care and 283 who had not) and 167 providers (100 of whom utilized TH/VC and 67 who had not) in the Southeastern and Midwestern U.S. during the COVID pandemic, were recently published in the journal Inquiry. 

Study findings 

Patients and providers were asked to rate on a scale from 0 (unsatisfied/disagree) to 100 (satisfied/agree) various queries, such as satisfaction with healthcare services during the COVID pandemic and willingness to try TH/VC in the future. Several themes emerged from the data. 

1. Patients were more satisfied with healthcare provider services during the pandemic than the providers themselves. Somewhat surprisingly, patients gave an average score of 89.4 on satisfaction, while providers gave a score of 74.7. One possible reason is provider burnout. The COVID pandemic greatly increased the stress of doctors and nurses. 
2. Patients who used TH/VC were less satisfied with healthcare provider services than those who did not use them. TH/VC patients gave an average rating of 84.1, while non-users gave an average rating of 92.4. This finding contradicts another study that found no difference in satisfaction, so the reason is unclear. Possibly TH/VC patients simply preferred in-person care.
3. Patients who used TH/VC were far more likely to say that they would use it again compared to patients who did not use TH/VC. Despite being slightly less satisfied, overall, TH/VC patients were open (score: 61.8) to future TH/VC services, while those patients who did not use it were largely opposed to ever trying it (score: 22.0).
4. Providers were not enthusiastic about TH/VC services. While TH/VC providers said they were likely to use TH/VC again, the average score (68.7) indicates that they aren’t incredibly excited about it. Providers who did not offer TH/VC remained mildly opposed to ever trying it (score: 43.4).
5. Patients and providers agree that TH/VC is easy to learn. Patients (score: 73.1) and providers (score: 74.2) did not have difficulty learning the technology.

Data table for patient/provider survey feedback

Barriers to greater telehealth/virtual care, use and solutions 

 Before COVID, few rehabilitation providers used TH/VC, and very few patients utilized it. Among our sample, only 11% of respondents had used TH/VC prior to COVID. After COVID, that proportion increased to 42%. Still, a majority of our respondents did not use TH/VC. Why? 

 The investigation indicates at least two major reasons:  

1. Lack of interest among patients. Humans are creatures of habit, and we especially do not like making changes to things that are highly personal, such as healthcare. In our study, patients who chose not to use TH/VC were older than those who did. This likely reflects a generational difference: Millennials and Gen Zers have grown accustomed to a digital world. Indeed, Gen Zers are widely considered “digital natives,” having lived nearly their entire lives in an internet-connected world. As these generations get older, most likely, use of TH/VC will increase naturally.

2. Uncertainty about insurance coverage. Both patients and providers expressed confusion about whether insurance companies would cover TH/VC services. Even though telehealth services were covered by insurance during the height of the pandemic, this fact was not widely known. Education campaigns by insurance companies and providers will be needed to overcome this barrier.

Researchers also believe that TH/VC use could be increased if doctors actively divided patients by identifying those who would be most interested in or would most benefit from telehealth. For example, doctors could make an effort to encourage younger patients or those with mobility problems to use TH/VC. Another strategy would be to employ mixed-delivery services. For instance, initial patient visits could be in-person, while follow-ups could be performed remotely. 

Read the full study Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study at Sage Journals.