The coronavirus pandemic changed the way in which healthcare services were delivered, including physical therapy.1 Social distancing and stay at home orders were implemented on a global scale to mitigate the spread of the virus.2 As such, physical therapists were forced to rapidly pivot in-person services to a digital environment virtually overnight, under immense pressure. Given that many physical therapists had little to no experience operating in a digital environment, this transition was often met with challenges. Despite a slow adoption of telehealth in physical therapy prior to the pandemic, research shows that telehealth-delivered physical therapy services for musculoskeletal and cardiorespiratory conditions and post-surgical patient rehabilitation3 provide equivalent, and in some cases superior, clinical outcomes when compared to traditional in-person services. Furthermore, evidence shows that it is technically feasible for physical therapists to assess, diagnose, and clinically manage patients via telehealth.4 The majority of physical therapists and patients who had first-hand experience using telehealth during the pandemic reported high levels of satisfaction, and a willingness to continue using it in the future.5,6 This suggests that telehealth is here to stay and will become a more common mode of delivery for physical therapy services in the future.

Despite research showing the feasibility, efficacy, acceptability, and safety of physical therapy services delivered via telehealth,3 several cross-sectional surveys and qualitative studies have identified a broad range of physical therapist-related barriers associated to implementation of telehealth in clinical practice.7,8 For example, many physical therapists lack confidence and skills in using telehealth to deliver care remotely, feeling unsure about using the technology, performing physical assessments, and developing therapeutic relationships with patients through a screen.7,9 Importantly, physical therapists also perceive a lack of resources available to up-skill themselves,7,10 and, recent research suggests that most physical therapists do not receive any specific training in telehealth.4,10 For example, World Physical therapy and the International Network of Physical therapy Regulatory Authorities found a lack of digital practice educational standards and guidelines within physical therapy programs across the United Kingdom and the United States of America.11 In addition, survey data of 207 physical therapists collected in Australia during the pandemic found that 85% received no prior training in telehealth.5 A recent Australian qualitative study found that physical therapy university educators acknowledge the important role that telehealth plays in contemporary physical therapy practice, and they recognise that telehealth is here to stay.12 However, there were substantial differences in the quality and scope of telehealth education provided by prelicensure physical therapy programs,12 with many universities providing little to no telehealth training. This was, in part, attributed to insufficient telehealth knowledge and expertise among staff. University educators also identified several unique barriers and facilitators regarding the implementation of telehealth education and training in entry-to-practice physical therapy programs. Among these factors, one of the most significant challenges was lack of telehealth knowledge (Fig. 1).

Fig. 1.

Barriers and enablers toward implementation of telehealth in pre-licensure physical therapy programs.

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To be able to safely and effectively deliver care via telehealth, physical therapists must be able to confidently adapt their in-person skills to a digital environment. Traditional physical therapy education focuses on preparing students for in-person care, but, given that physical therapy is traditionally a ‘hands-on’ profession, physical therapists face unique challenges when adapting their care to telehealth delivery. Research shows that many physical therapists and physical therapists-in-training want to develop their skills to provide services via telehealth.13,14 Indeed, World Physical therapy has also called for the upskilling of physical therapists in telehealth delivery.11 Prior research, utilising international Delphi techniques across expert panels of physical therapists, researchers, and consumers, has identified the capabilities that are required by physical therapists to deliver care via videoconferencing15 and telephone.16 The resulting capability frameworks, comprising 60 capabilities across seven domains for videoconferencing, and 44 capabilities across six domains for telephone, included skills relating to complying to laws/regulations, maintaining patient privacy and confidentiality, ensuring patient safety, using the technology effectively, adapting care to telehealth delivery, providing appropriate assessment and diagnosis, and developing care/management plans. These capability frameworks can be used to inform the content of future telehealth training programs, ensuring that clinicians are upskilled in all the necessary and required expertise for telehealth delivery.

Currently, few comprehensive discipline-specific telehealth training courses exist for physical therapists. Online courses on Coursera (eg ‘Telehealth Best Practices and Uses’ https://www.coursera.org/learn/telehealth-best-practices-uses), Alison courses (‘Telehealth for healthcare providers’https://alison.com/course/telehealth-for-healthcare-providers), Johns Hopkins University (‘Foundations of telehealth’ https://www.careers360.com/university/johns-hopkins-university-baltimore/foundations-of-telehealth-certification-course), and Charles Sturt University (‘Telehealth: Embracing technology in healthcare’, Three Rivers https://threerivers.csu.edu.au/telehealth/telehealth-education#:∼:text=Telehealth%3A%20Embracing%20technology%20in%20healthcare&text=It%20incorporates%20a%20range%20of,in%20the%20Three%20Rivers%20footprint) are freely available, but not specifically designed for physical therapy practice. Other online courses, such as those available on FutureLearn (‘Physical therapy Exercise and Physical Activity for Knee Osteoarthritis’17https://healthsciences.unimelb.edu.au/departments/physical therapy/chesm/clinician-resources/peak-training), Physiopedia.com (‘Introduction to telehealth’ https://www.physio-pedia.com/Introduction_to_Telehealth), and the American Physical Therapy Association learning center (Telehealth certificate series https://aptatherapists.elevate.gocadmium.com/p/TH-CERT) are specifically designed for physical therapists, but were developed prior to the telehealth capability frameworks, and therefore many do not address all key skills and requirements. A new telehealth training program “Telehealth in Physical therapy Clinical Practice”, developed in conjunction with current evidence and the capability frameworks, has been developed for pre-licensure physical therapy education. Included in this e-learning program is a teacher's toolbox. The toolbox provides educators with predeveloped assessments, marking rubrics, as well as ideas to integrate telehealth discussions into tutorials and/or practical classes. Although this program has been designed as an introductory to telehealth as a delivery mode and will have the potential to standardize pre-licensure physical therapy telehealth training in Australia, many of the principles and content within the course are transferable internationally. The program will be housed within an online learning management system and will be available for purchase by universities. However, the effectiveness of the program has not yet been evaluated. Further, the development and evaluation of more comprehensive telehealth training programs, suitable for physical therapists who want to learn the specifics of how to deliver care telehealth, are still needed.

In summary, telehealth training programs are urgently required in physical therapy to future-proof the profession and ensure that the emerging workforce is confident and capable in providing care in a digital environment. Existing telehealth training programs are either not developed specifically for physical therapists, or do not address all of the unique capabilities required by physical therapists to deliver care remotely. However, some new training programs are in development and will help standardise telehealth education in pre-licensure programs and post-graduate initiatives. Educators must be willing to prioritise such education and training within physical therapy curriculum.