Report - Remote Physiotherapy Consulta ons in the Belgian Primary Health Care Context: Lessons learned during the covid-19 pandemic

Abstract

It is clear from the literature that blended physiotherapy, i.e., a combination of remote and face-to-face consultations, is an effective and cost-effective form of treatment for a range of conditions. Moreover, as the number of people requiring physiotherapy is increasing and will further increase in the coming years, concurrently with the aging of the population and a growing disability epidemic, this practice may help alleviate the pressure on the healthcare system. However, neither remote nor blended physiotherapy are regularly used in Belgium and there is no permanent legal framework for their reimbursement. This is in contrast with the Netherlands, where coding and billing of remote physiotherapy is possible since August 2020. Due to the COVID-19 pandemic, a temporary reimbursement for remote physiotherapy sessions has been implemented in Belgium to ensure access to care while limiting the risk of infections. This created an opportunity to assess the experience with, and the general opinion on, new forms of physiotherapy in both patients and physiotherapists, which in turn could help policy makers make informed decisions about the position of remote and blended physiotherapy in the Belgian healthcare system. In this context, two surveys in Dutch and in French were developed and disseminated: one for Belgian primary care physiotherapists and one for patients. A total of 1567 primary care physiotherapists, of which 643 provided remote physiotherapy during the COVID-19 pandemic, and 183 patients, of which 35 received remote physiotherapy during the COVID-19 pandemic, completed the respective survey. Overall, more than half of the physiotherapists and patients supported the use of blended physiotherapy. This was more pronounced for physiotherapists who provided remote physiotherapy during the COVID-19 pandemic and for patients who received it as opposed to those who did not. It should be noted that the acceptance of remote physiotherapy as a stand-alone therapy, as implemented during the COVID-19 pandemic, was lower than when it was combined with face-to-face therapy. Physiotherapists not familiar with remote physiotherapy were less convinced of its usefulness, and a higher percentage reported potential barriers associated with this form of therapy. This clearly indicates the importance of lowering existing barriers and promoting the use of remote physiotherapy to escape the current “unknown makes unloved” impasse. Both physiotherapists who provided remote therapy as well as physiotherapists who did not, reported the inability to give hands-on therapy as the main barrier to using remote physiotherapy as a stand-alone approach. The results of the patient survey showed the same trends: a higher percentage of patients who did not receive remote physiotherapy indicated potential barriers compared to those who did. The inability to receive hands-on therapy was also the most frequently reported barrier by both patients who received remote physiotherapy and by those who did not. The majority of patients receiving remote physiotherapy during the COVID-19 pandemic for a complaint for which they already received face-to-face physiotherapy before the COVID-19 pandemic indicated that remote physiotherapy sessions were comparable to or better than faceto- face physiotherapy sessions when assessing important aspects of person-centered care, such as guidance towards self-management, creating a therapeutic bond and attention for the personal environment and situation. Furthermore, most patients indicated willingness to pay for telephone or video consultations, especially the patients already receiving these services. When questioned about the challenges of implementing blended physiotherapy in daily practice, physiotherapists reported that they expect to encounter problems in determining whether a patient is suited for blended physiotherapy. Furthermore, the majority of therapists estimated that only a minority of their patients is eligible for blended therapy. In addition, although most physiotherapists supported the use of blended physiotherapy, a large percentage believed that it will be difficult or very difficult to integrate blended physiotherapy into their daily practice. Important requirements listed by physiotherapists were the availability of tools or applications that are safe, user-friendly and accessible. This may indicate the need for a portal site where physiotherapists can find easy access to such tools. Finally, according to the vast majority of physiotherapists, the preservation or increase of the rates for remote physiotherapy is also a requirement. To achieve a wider acceptance of remote and blended physiotherapy and to ensure a smooth implementation of these new forms of physiotherapy in daily practice, it is important to address the concerns and needs of both patients and physiotherapists. One of the main ways to achieve this is by providing a clear and correct legal structure in which the reimbursement of these remote treatments is addressed. Physiotherapists (and physiotherapy students) should also be trained in all legal, technical and clinical aspects related to remote or blended physiotherapy. This is the only way to ensure a sustainable and future-proof use of new technologies in physiotherapy.