Telehealth - Video Consultations
What is Telehealth?
There has been growing consumer desire for access to video-consultation services provided by physiotherapists for years. However, with the advent of COVID-19 there has been a rapid and unprecedented demand for a telehealth solution. There's good evidence to suggest that physiotherapy services delivered via video consultation are cost effective, safe and well-received by consumers. Historically, this has been useful for those who live in rural and remote locations and those with significant mobility issues, eg, consumers with neurological condition who have limited capacity to travel. Below we've compiled some frequently asked questions for utilising telehealth appointments at Sycamore Health.
How do I book an appointment?
If it's the first time you’ve had an appointment at Sycamore Health Physiotherapy, if you’ve attended before but are wanting a consultation for a new issue OR you haven’t been to the clinic in over 6 months, then please select the “Physiotherapy - Telehealth Initial” option. If you have had an appointment with us before (either online or in person) and are wanting a follow up for the same issue, then please select the “Physiotherapy - Telehealth Subsequent” option.
Once your appointment has been booked make sure you have your PC, tablet or phone at the ready when it comes time for your appointment. Before the time your appointment is scheduled to start we will send you an e-mail with a link for you to join the consultation. Follow the instructions from the e-mail for your consultation to begin.
Do I need any specific software or equipment for the consultation?
We use Zoom for our telehealth consultations. You can download this at https://zoom.us/ - just click the “sign up free” link, or you can download it from the app store if using a phone or tablet. If you haven’t downloaded the software at the time of your appointment, don't stress! The e-mail we send you will have a link you can click to start the download.
For the consultation itself, make sure you’re wearing comfortable clothing. If you have any exercise equipment at home we suggest you have that close by. Where possible try to set yourself up in a well-lit room, have space to perform some exercise, and have no distracting noises nearby for the best audio quality.
Please be ready and on standby 5-10 minutes before the scheduled time of your appointment to ensure things are running smoothly by the time your appointment is due to start.
What will an online telehealth consultation look like?
Initially we’ll start the consultation as we would any consultation. We’ll ask you some questions to help us get a thorough idea of what might be causing your problem. Diagnosis is the cornerstone of good management and this can be done with an in-depth interview. If the diagnosis isn’t correct then the treatment might not be targeting the primary cause/s. Where possible, we will 'screen share' with you. This is where we can 'share' our computer screen with you to show you some important information/pictures/graphics/research to aid accurate understanding.
After we’ve performed our assessment we’ll be able to discuss our findings with you and let you know what the most likely problem may be. From there we’ll be able to advise you what can be done to ease your symptoms.
Are telehealth consultations actually helpful? Don’t you need some sort of hands-on therapy like massage?
While the idea of an online physiotherapy consultation is not common in metropolitan areas in Australia, it's used extensively to reach people in remote and rural regions where they may have less access to quality healthcare. There is a large evidence-base and experience amongst healthcare professionals on how to conduct effective management and advice over an online consultation. This research shows that online physiotherapy produces comparable results to physiotherapy treatment received in clinic! (1, 2)
Passive interventions (like massage, manipulations, mobilisation etc.) can offer some temporary relief. However, active interventions (like exercise) create long-term change and pain relief. The truth is that the bulk of the value of a physiotherapy session is in 1) accurate assessment and diagnosis, 2) specific advice and education, and 3) appropriate rehabilitation exercises. All of these can be effectively delivered via a telehealth consultation.
If there is a great need for pain-relieving treatment, we can guide you through some of these manual therapy techniques yourself! This will foster independence regarding your management and equip you with knowledge and skills that will serve you for the rest of your life. Self-management strategies encourage you to take an active role in your own rehabilitation.
Can you give me a clinical example of this?
Glad you asked! Let’s take one very common clinical example – low back pain. The NICE guidelines (these are evidence-based guidelines developed in the UK) list some important things to do in the management of low back pain:
- An assessment is required, most of this is done through asking specific questions and getting a thorough history to help understand what might be causing the issue and if referral to another service may be required.
- Effective management would then involve education and self-management strategies (such as a specific exercise program). Manual therapy would be considered an adjunct that may help alleviate some acute pain, which we can guide you on how to do at home (but not essential for your overall recovery).
I’ve had appointments at the clinic before, am I able to have an online consultation?
Yes, we’ll be able to discuss how your condition has been progressing and upgrade or modify your rehab program based on this. Through the video link we’ll be able to observe how you’ve been performing your exercises and make any modifications, adjustments and progressions. Through an online telehealth consultation, we’ll have the ability to monitor symptoms and fine tune your rehab to keep your recovery optimal!
How much will an online telehealth consultation cost? What payment methods are available? (Medicare, DVA, private health insurance, Work Cover etc.)
Medicare: Telehealth consultations under a CDM plan (also known as EPC plans) are bulk billed. A valid referral is required from your GP. You may ask your GP or practice nurse to assign you physiotherapy as a chosen provider as apart of your team care arrangement. Those with existing CDM plans do not need to renew their referral; you are eligible straight away for telehealth physiotherapy.
DVA: Telehealth has been accepted by The Department of Veterans' Affairs for physiotherapists who treat DVA patients! Please let us know if this is something you would like to commence moving forward and we'll organise your initial Telehealth consultation!
Private Health Fund (PHI): Patients who would like to claim rebates with their private health funds for telehealth appointments can do so from the 14th of April 2020. Existing patients of Sycamore Health with injuries that have already been treated during the past 6 months will be eligible to claim telehealth rebates straight from the 14th. Patients with new injuries, who haven’t received treatment within 6 months, or who are new to Sycamore Health, will be required to visit a GP first and obtain a referral suggesting that physiotherapy is “required”. We are aware that this seems redundant and places you at unnecessary risk by having to visit a GP first when the physio can normally make this decision with you, and we are lobbying to PHI’s to have this caveat amended. For now, our recommendation is that these patients contact their usual GP for a phone consultation and have this referral sent securely to us via electronic means. Patients will then be able to utilise their private health rebates ongoing for telehealth.
Work Cover: Patients with new or existing work cover claims that are open and have a valid referral for physiotherapy are eligible for telehealth consultations immediately.
Third Party Insurance: If you are claiming personal medical insurance or non-liability accident insurance, there is no current generalised ruling for physiotherapy telehealth. Therefore, we recommend contacting your case manager prior to booking your telehealth physiotherapy appointment. Appointments can be made on a case-by-case basis.
Are telehealth consultations private and secure? Is my consultation recorded?
Your consultation is not recorded. Moreover, telehealth appointments using Zoom have end-to-end encryption. End to end encryption is intended to prevent data being secretly accessed or modified, other than by the true sender and recipient(s). The messages are encrypted by the sender - a third party does not have a means to decrypt them.
If you have any other questions, please do not hesitate to call or email any of your concerns or queries. You can also visit Zoom's FAQ here.
1. Speyer R, Denman D, Wilkes-Gillan S, Chen YW, Bogaardt H, Kim JH, Heckathorn DE, Cordier R. (2018). Effects of telehealth by allied health professionals and nurses in rural and remote areas: a systematic review and meta-analysis. Journal of rehabilitation medicine, 50(3), 225-35.
2. Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. (2017). Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ open, 7(8).