Main themes from the National Evaluation of Remote Physiotherapy Services

Purpose of consultation

  • The method of delivery should be flexible and personalised taking into account the purpose of the intervention/consultation.
  • For many people, this may mean a mixture of in-person and remote approaches at different stages of their physiotherapy
  • Some types of intervention/consultation may be less feasible when delivered remotely, for example, if hands-on examination is needed and also dependent on the remote approaches available
  • The efficiency and effectiveness of different types of intervention/consultation may vary according to whether delivered remotely or in person and the remote approaches available

Remote approaches available

  • This includes a range of approaches, for example, video, telephone and interactive platforms
  • This is dependent on available technology for the person, physiotherapy workforce and organisation

The person

There are 7 main themes

  1. Preference
  2. Experience/satisfaction
  3. Clinical presentation
  4. Communication
  5. Safety/perception of risk
  6. Convenience and cost
  7. Technology

1. Preference

  • Patient preference is influenced by a range of factors including perception of accuracy and effectiveness of the consultation; convenience, cost, and availability for work/other responsibilities; accessibility, previous experience, performance and familiarity of technology
  • Preference varies according to the remote approaches available and the purpose of the consultation
  • Patient preference is significantly influenced by external factors such as a pandemic and perceptions of risk

2. Experience/satisfaction

  • Patient experience/satisfaction is influenced by patient preference
  • Key factors influencing patient experience are the quality of the technology, convenience in terms of travel and time away from work or other commitments and cost

3. Clinical presentation

Physical and mental health needs

  • The individual physical and mental health needs of some people may present challenges for remote delivery especially where physical assessment is required
  • Some individuals benefit from remote physiotherapy due to the physical and mental health needs they experience, for example, when discussing sensitive issues or when symptoms are aggravated by travel and different environments

4. Communication

  • This includes learning needs, cognitive ability, vision, hearing and language
  • There is a perception from some respondents that remote delivery may not be suitable for some individuals with cognition, language, learning or sensory needs
  • The potential of technology to enhance communication has not been evaluated

5. Safety / Perception of risk

  • There is limited evidence for the safety of remote consultation or evaluation by services

5.1 Physical safety

  • A key issue for patients at risk of falling especially if they are alone at home
  • The exact location/address of the patient may not be known in case of emergency

5.2 Environment

  • The home environment may have safety hazards
  • The home environment may present issues for privacy/confidentiality

5.3 Clinical safety

  • Accuracy of assessment and diagnosis may be compromised by not being able to undertake hands-on examination and/or reduced visual detail

5.4 Technology

  • This includes, access, digital literacy, training, support, functionality, usability, familiarity, software compatibility

5.4.1 Confidentiality

  • Issues in relation to information governance, in particular confidentiality and data protection

5.4.2 Performance

  • Low quality technology may compromise patient safety issues

5.5 Infection control

  • An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff

6. Convenience and cost


6.1 Cost

  • No travel or parking costs with remote sessions

6.2 Time

  • Remote sessions can be delivered without travel time or car parking challenges which will all save the patient time

6.3 Work/other responsibilities

  • Less time and travel means that patients will feel less impact on their family lives

7. Technology

  • This includes, access, digital literacy, training, support, functionality, usability, familiarity, software compatibility
  • Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
  • Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
  • Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

The physiotherapy workforce

There are 3 main themes:

  1. Individual factors
  2. Safety/perception of risk
  3. Technology

1. Individual factors


1.1 Preference

  • For some respondents, in person physiotherapy is non-negotiable
  • Other participants, whilst preferring in person, acknowledged the importance of providing person centred physiotherapy and are willing to work combining in person and remote delivery

1.2 Experience/satisfaction

  • For most participants the start of the pandemic was a difficult and stressful time with a high degree of uncertainty and rapid change
  • During the pandemic experiences varied, for some it was challenging not being able to use their ‘hands on’ expertise and skills whilst others felt they had developed and utilised different skills
  • In terms of work location, some participants working from their home felt isolated and missed the interactive and social parts of working with others
  • Positive and negative experiences related to access to and performance of technology, effective leadership and organisational support

1.3 Professional identity

  • For some respondents, therapeutic touch and ‘hands on’ skills are a fundamental part of their personal identity as a physiotherapist and essential for accurate assessment and effective treatment
  • Some physiotherapists felt that remote delivery challenged the identity of physiotherapy as a profession and would impact on training for the next generation of the physiotherapy workforce

1.4 Personal safety/perception of risk

These relate to infection control

  • An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff
  • In relation to the working environment, the need for policy around sharing equipment, for example, computers and headphones, was raised

1.5 Knowledge and skills

This includes both clinical and technical skills

1.6 Response to change

  • Many found the rapid change to remote delivery disruptive and challenging
  • However, some saw it as an opportunity to develop new skills and 'think outside the box'

1.7 Leadership

  • The effectiveness of transferring to remote services was felt to be dependent on proactive leadership including skilled management of change and team dynamics, flexibility and knowledge and confidence with technology

2. Safety/perception of risk

  • There is limited evidence for the safety of remote consultation or evaluation by services

2.1 Physical safety

  • A key issue for patients at risk of falling especially if they are alone at home
  • The exact location/address of the patient may not be known in case of emergency

2.2 Environment

  • The home environment may have safety hazards
  • The home environment may present issues for privacy/confidentiality

2.3 Clinical safety

  • Accuracy of assessment and diagnosis may be compromised by not being able to undertake hands-on examination and/or reduced visual detail

2.4 Technology

2.4.1 Confidentiality

  • Issues in relation to information governance, in particular confidentiality and data protection

2.4.2 Performance

  • Low quality technology may compromise patient safety issues

2.5 Infection control

  • An important benefit of remote delivery during the pandemic related to infection control and shielding for both patients and staff
  • In relation to the working environment, the need for policy around sharing equipment, for example, computers and headphones, was raised

3. Technology

  • Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
  • Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
  • Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

  • Digital inclusion is a key factor for deciding how physiotherapy is delivered. This includes consideration of access to technology, performance of technology, digital literacy, training and support
  • Some services collect data on uptake and attendance rates for remote physiotherapy but there was no data in relation to digital exclusion or other factors influencing uptake rates
  • Technology used should be fit for purpose, easy to use, safe, and compatible with other appropriate software and hardware

    The organisation

    There are 6 main themes:

    1. Evaluation

    2. Resources

    3. Training and support

    4. Workload

    5. Culture

    6. Organisation issues

    1. Evaluation


    1.1 Outcome measurement

    • 53% of the 1,620 respondents to the survey evaluated patient outcomes

    1.2 Digital inclusion

    • 19% of the 1,620 survey respondents collected data on those who were unable or unwilling to use a remote service
    • Four out of twelve case study services collected data on uptake of remote services which ranged from 14 – 53%. Some services also collected attendance rates. No services collected data on why remote services had not been taken

    1.3 Patient experience/satisfaction

    • Half of the services in the survey and case studies evaluated patient experience/satisfaction
    • A variety of measures are used by services and reported in the literature. Very high levels of satisfaction and positive experiences are reported
    • No services compared satisfaction or experience of remote with in person services

    1.4 Staff experience/satisfaction

    • 20% of the 1,620 respondents to the survey reported evaluating staff experience or satisfaction
    • A quarter of the case studies evaluated staff experience or satisfaction. They used questionnaires, workshops and reflections on learning and how things could be improved. Feedback was mixed

    1.5 Time

    • 21.3% of the 1,620 respondents to the survey evaluated time taken to deliver remote consultations
    • Many services reported extra time being needed to provide remote services but this was mainly in relation to setting up a new service. This involved researching and making decisions about the type(s) of technology to use, planning and problem solving, development of policies, resources and support materials, adapting assessment and evaluation processes and time for training in using the technology and new clinical skills
    • Additional time was needed to assess or triage individual patients to decide whether remote delivery would be feasible and/or appropriate for them
    • Remote consultations reduced time for services where staff would normally have to travel, in particular for community services

    1.6 Cost

    • 12.5% of the 1,620 respondents to the survey evaluated cost
    • None of the case studies evaluated the cost of delivering remote physiotherapy
    • Measurement of the cost of physiotherapy service delivery is complex and varies in relation to many different factors and the type of service. Set up costs need to be taken into account as well as ongoing cost
    • Costing for private physiotherapy services can be unpredictable due to uncertainty regarding health insurance payment for remote services
    • There is no good quality evidence or data comparing the cost of remote and in person physiotherapy despite the perception by some that remote delivery reduces costs

    1.7 Patient and public involvement

    • Just over a quarter of the 1,620 services who responded to the survey reported that they involved users in developing the service
    • Only 10% of services involved users in developing evaluation measures

    2. Resources

    • This includes the environment or workspace, equipment and technology (availability, functionality and software compatibility)

    3. Training and support

    • This includes both clinical and technical knowledge and skills

    4. Workload

    • This includes the amount, pattern and intensity of workload

    5. Culture

    • This is influenced by leadership at both organisation and service level

    6. Organisation issues

    • This includes governance, policy, regulation, guidance and standard operating procedure, costs, insurance and legal issues

    The physiotherapy profession

    There are 3 main themes:

    1. Professional identity
    2. Research
    3. Education

    Wider issues

    There are 5 main themes:

    1. Governance
    2. Policy
    3. Regulation
    4. Professional guidance
    5. Technology
    Last reviewed: