Virtual Care: What It Can’t Do (And Why That’s Okay)
While research shows virtual rehabilitation can be as effective as in-person care, it’s important to recognize that it isn’t perfect. Understanding its limitations helps patients make informed choices and know what to expect before starting virtual care.
Lack of Physical Interaction
One of the most common themes in the research evaluating virtual care is how patients view the physical aspect of injury assessment and treatment. Obviously, physical interaction is not there with virtual care, which many patients felt affected their ability to develop rapport with their therapists, leading to an impersonal relationship. Some people feel more natural and personable when they are face-to-face with a therapist as they can get a better sense of tone and body language. It can be hard for some to replicate casual conversation through a computer screen and therefore may find it harder to build that connection and trust.
Lack of Physical Contact
Understandably, many patients feel a big part of the injury rehabilitation is the physical touch aspect. Physical touch is used in many ways during assessment, such as to test range of motion and strength, feel for muscle tone and tenderness, see swelling and movement tests, or even just to provide comfort and reassurance. As well, many people value the physical contact during treatments through either manual therapy or assistance with exercises. While manual therapy is not the main driver of recovery, it can play an important role in calming symptoms, relieving stress, restoring comfort, and building confidence in movement, all things that can make a difference early in rehab.
Perception of Inferiority
Because of the lack of physical interaction and touch, some patients may feel virtual care is inferior to in-person care. Some patients have noted not feeling confident in the therapist’s assessment because of this lack of touch, and may feel that advice, education, and guided exercises are not adequate enough. This can have an impact on motivation and expectations, which affect the outcomes of treatment.
Not Suitable for Every Condition
While virtual care is suitable for many of the common musculoskeletal conditions, it does not work well for all. Post-operative patients usually require early and consistent mobilization— while this can certainly be guided virtually, having that physical touch and leverage can help patients push a bit further than they might on their own. When it comes to return-to-play decisions, having valuable objective measures like equal range of motion, strength, and power can make better informed decisions. Certain symptoms like numbness or loss of strength may require a more thorough neurological exam that is better done in person. Patients may even feel safer when completing exercises by having someone beside them to guide or adjust movements or even motivate them. These are examples where in-person care may be more beneficial, but virtual care can still play a role in determining what’s appropriate and in helping guide recovery.
Technology Isn’t Always Perfect
Current technology is amazing, but it is not always easy to use or reliable. Bad internet connection leading to audio and visual lagging or poor lighting and camera angles can make an appointment frustrating and a less than ideal experience. Comfort and technology literacy can be an issue too, as some patients may not feel confident doing video calls or using the programs/websites that provide their home exercise program. Some patients may even have concerns regarding the safety, privacy, or confidentiality of online video calls. While the programs that Bend Without Breaking use are GDPR-compliant, these are still valid and understandable concerns.
Some patients in the literature reported being sceptical of virtual care at first but later embraced it. Still, virtual care isn’t for everyone — and that’s okay. Some people simply prefer the structure, environment, and physical interaction of in-person care. What matters most is that your treatment feels valuable and effective for you. Virtual care isn’t here to replace in-person care, but to make quality rehab more accessible, practical, and convenient.
References:
Barton, C. J., Ezzat, A. M., Merolli, M., Williams, C. M., Haines, T., Mehta, N., et al. “It's second best”: A mixed-methods evaluation of the experiences and attitudes of people with musculoskeletal pain towards physiotherapist delivered telehealth during the COVID-19 pandemic. Musculoskeletal Science and Practice. 2022; 58, Article 102500. https://doi.org/10.1016/j.msksp.2021.102500.
Bennell KL, Marshall CJ, Dobson F, Kasza J, Lonsdale C, Hinman RS. Does a web-based exercise programming system improve home exercise adherence for people with musculoskeletal conditions?: A randomized controlled trial. Am J Phys Med Rehabil. 2019; 98 (10): 850-858. doi: 10.1097/PHM.0000000000001204.
Bucki FM, Clay MB, Tobiczyk H, Green BN. Scoping review of telehealth for musculoskeletal disorders: applications for the COVID-19 pandemic. J Manipulative Physiol Ther. 2021; 44 (7): 558-565. doi: 10.1016/j.jmpt.2021.12.003.
Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehab. 2017; 31 (5): 625-638. doi: 10.1177/0269215516645148.
Cottrell MA, O’Leary SP, Raymer M, Hill AJ, Comans T, Russell TG. Does telerehabilitation result in inferior clinical outcomes compared with in-person care for the management of chronic MSK spinal conditions in the tertiary hospital setting? J Telemed Telecare. 2021; 27 (7): 444-452. doi: 10.1177/1357633X19887265.
Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract. 2020 ;48: Article 102193. doi: 10.1016/j.msksp.2020.102193.
Cronström A, Sjödahl Hammarlund C. "A feeling of being part of the future": a qualitative study on physical therapists' experiences of delivering digital first-line treatment for hip and knee osteoarthritis. Physiother Theory Pract. 2025;41 (5): 998-1007. doi: 10.1080/09593985.2024.2380478.
Fernandes LG, Devan H, Williams CM. At my own space, pace and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain. Pain. 2022; 163 (2): e165-e181. doi: 10.1097/j.pain.0000000000002364.
Fraser C, Beasley M, Macfarlane G, Lovell K. Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability. BMC Musculoskelet Disord. 2019; 20 (1):198-1008. doi: 10.1186/s12891-019-2584-2.
Koppenaal T, Pisters MF, Kloek CJ, Arensman RM, Ostelo RW, Veenhof C. the 3-month effectiveness of a stratified blended physiotherapy intervention in patients with nonspecific low back pain: cluster randomized controlled trial. J Med Internet Res. 2022; 24 (2): e31675. doi: 10.2196/31675.
Lawford BJ, Delany C, Bennell KL, Hinman RS. "I was really sceptical...But it worked really well": a qualitative study of patient perceptions of telephone-delivered exercise therapy by physiotherapists for people with knee osteoarthritis. Osteoarthritis Cartilage. 2018; 26 (6):741-750. doi: 10.1016/j.joca.2018.02.909.
Seron P, Oliveros MJ, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro RC, Merino-Osorio C, et al. Effectiveness of telerehabilitation in physical therapy: a rapid overview. Phys Ther. 2021; 101 (6): 1-18. doi: 10.1093/ptj/pzab053.
