Forum: Limitations to conducting physiotherapy via video consultation

I refer to the letter by the Singapore Physiotherapy Association (Suspension of physiotherapy treatment may be detrimental for some patients, April 19).

I appreciate the association's stance regarding the detrimental effects of suspending physiotherapy services during the circuit breaker period, which has been extended until June 1.

There is definitely a need to curb the transmission of Covid-19 in the community.

I am currently utilising telephysiotherapy/consultation via video conferencing to serve some patients. While research has supported the use of telehealth, there are real limits to its capabilities.

First, due to frozen and patchy videos, blurred and degraded images, limited camera placement as well as the poor technical skills of patients and their carers in handling digital video technology, it is not possible to complete necessary movement assessment and analysis. Movement assessment greatly guides our clinical judgment and patient safety.

Second, necessary hands-on intervention that is required following essential surgery cannot be completed. Examples include the passive mobilisation that is required following surgery to repair fractured bones and ruptured tendons.

Third, some patients who have post-traumatic stress syndrome may be unwilling and unmotivated to perform telephysiotherapy due to distress and helplessness. Such patients require extra reassurance and manual guidance to undergo essential treatment.

Fourth, for neurological patients who have been on robotic gait rehabilitation, ceasing treatments may mean regression of physical outcomes such as walking. The negative impact of the regression in their rehabilitation will disrupt long-term recovery and increase mental unease at what is already a challenging time.

Fifth, per government advisories, physiotherapy services may continue during the circuit breaker period if solely telephysiotherapy is provided. It is uncertain if all insurance companies allow telephysiotherapy as an outpatient treatment, similar to face-to-face physiotherapy treatment. If it is disallowed, patients may feel burdened by the unexpected medical costs amid current economic uncertainties.

Physiotherapists can determine who requires in-person treatment and how to integrate telephysiotherapy to reduce contact. We can reduce the number of patients we see while ensuring that we are not placing undue risk on those who are potentially vulnerable.

There is a serious risk of immediate complications arising from not being able to access physiotherapy, putting further pressure on the healthcare system. There is an urgent need to reconsider physiotherapy services essential.

Ai Ni Lau

Principal Physiotherapist

United Rehabilitation And Physiotherapy Centre