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The Definition of Essential Care, Through Physical Therapy

LAUREN PEACE, HOST: Many healthcare services have been either cancelled or moved online due to the pandemic. Others are considered essential. But how do you decide what qualifies as essential care? And who decides? It’s a question many providers are confronted with right now, including physical therapists. Both New York state and federal guidelines qualify physical therapy as an essential service. But, as Lucas Brady Woods finds, for therapists and patients that decision is not always so clear-cut.

LUCAS BRADY WOODS, BYLINE: After 57-year-old Janet Henderson had knee replacement surgery this winter, the healing process was problematic. She needed surgery again last month.

JANET HENDERSON: Like, I can’t clean the bathtub. My knee doesn’t bend well enough to do those things. I can’t get down on my knees and play with the dog. I mean what’s the point of surviving COVID if you can’t really enjoy what you want to do on the other side of it.

WOODS: So she’s counting on physical therapy to help her regain as much mobility as possible.

Henderson speaks to her physical therapist.

WOODS: But this isn’t a video chat or phone call. Henderson is going in person. She works in film production. That means she has to be on her feet for hours at a time on set, so she says regaining mobility is important. But she also says it wasn’t an easy decision to keep going in person. Henderson’s son, who’s 23, lives with her, and he has asthma that could make him vulnerable to COVID-19.

HENDERSON: I had a conversation with my son about it, and he was pretty adamant that I continue with it. We kind of made it a family decision, how I should keep going.

WOODS: A lot of physical therapy patients are struggling with the same question. On one hand they may need to learn to walk again after a stroke, to get dressed after surgery, or even manage diabetes with exercise. On the other hand, physical therapists use their hands to treat patients’ bodies. But that can mean spreading germs, which leads to the question: what care is so essential that it can’t wait? and who decides?

Some PT patients have been moving to phone and online appointments. Evan Greene, a therapist on Long Island, is still seeing some patients in-person but also treats others virtually. He says telehealth can’t replace essential in-person care.

EVAN GREENE You can’t put your hands on a patient. You can’t assess things such as joint mobility, see what their flexibility is really like. It’s very observational so you might not catch certain nuances that you would catch in the clinic.

WOODS: But if a patient is at increased risk for COVID-19, Greene recommends remote therapy. He says many of these patients are older adults, and that creates additional challenges.

GREENE: And the problem is, in terms of telehealth, they’re not technologically savvy enough, a lot of them, and they’re just like, “No, I’ll wait till you reopen again or when it’s safe to come out.” So now think about these patients that are sedentary for a period of four to six weeks or longer.

WOODS: Greene says the decision about which treatments should continue in-person must include a conversation with the patient.

But for some PTs, the decision to suspend in-person appointments is made for them. Theresa Marko is with the American Physical Therapy Association. She also has a small Upper West Side practice and moved her entire clinic online.

THERESA MARKO: People didn’t want to come, I didn’t have enough personal protective equipment, and couldn’t socially distance, and I didn’t really have any acute clients, so I just said this is not going to work out. Time to just close the doors temporarily.

WOODS: Marko says the bottom line is that physical therapists need to approach this crisis responsibly.

MARKO: Even though we are essential, what does that mean in practice. You have to ask yourself, you know, is it critical that you see this person face to face.

WOODS: But it’s not easy. For the few patients who did want to come in, she’s had to make some tough choices.

MARKO: Having to tell them that you can’t come to the office and help them is a very visceral feeling. You feel really bad. You feel like wow I’ve let you down. So yeah it is painful. At least I’m happy that I can provide some services to a few people that are appropriate for the telehealth.

WOODS: As for Janet Henderson, the video producer, she considered continuing her therapy remotely, but says she just can’t achieve the same results doing exercises on her own. So, she continues to see her physical therapist twice a week, in-person. Lucas Brady Woods, Columbia Radio News.


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