Choosing virtual, hybrid or in-person physiotherapy: a practical guide for patients and caregivers

What the comparative evidence says

In REFORM, the lower end of the PSFS confidence interval (−3.5) remained above the trial's −15-point non-inferiority margin. That supports non-inferiority for this primary, six-week self-reported function outcome in the studied population; it does not establish universal equivalence. The program included an in-person session and remote support by phone, text and app. (Trial details)

The video review found a possible attendance advantage, but its estimate was uncertain because the 95% confidence interval included no difference. Exercise adherence was estimated to be higher with video, while satisfaction was similar on average. Because certainty was very low to low, these pooled estimates should be treated as clues—not guarantees for an individual appointment or program. (Review details)

The American Physical Therapy Association's 2024 guideline provides seven recommendations addressing the impact, preparation and implementation of telerehabilitation. It considers benefits, harms and implementation costs, and includes a range of clinical topics. It is a professional guideline, not a one-size-fits-all patient assignment tool. (APTA guideline summary)

A practical way to choose

Think of the choice as a conversation with your physiotherapist. These are prompts, not a self-assessment or a validated scoring system.

Virtual may be worth discussing when…

These points describe possible fit, not proof that virtual care is right for a particular person. Clinical suitability should be assessed by the treating professional.

• The planned visit is mainly conversation, education, exercise coaching, review of progress or support with a home program.
• You can hear and see the therapist clearly, and the therapist can see the movements or activities they need to observe.
• You have a suitable device, reliable connection, enough privacy and a safe space to participate.
• Travel, time away from work or caregiving, distance, or mobility barriers make clinic visits difficult.
• You and your therapist agree on how progress will be checked and when to change the plan.

Hybrid may fit when…

Hybrid care is not automatically the best option, but it can be a reasonable discussion when the advantages of remote access and in-person assessment both matter. The REFORM trial is an example of a supported program with both remote components and one in-person visit—not proof that every hybrid schedule will have the same results. (REFORM trial)

• Some parts of care can be coached remotely, while an in-person examination, physical assistance, equipment or measurement may be useful at another point.
• You are beginning a plan and would value an in-person assessment, followed by remote coaching or check-ins.
• The therapist needs to see how you manage exercises at home but also wants to reassess in person if progress or the examination leaves questions.

In-person may be important when…

Do not use this article to decide whether a symptom is serious or to delay care. If you are worried about a new or worsening problem, contact a qualified health professional; if you believe you need urgent help, use local urgent or emergency services.

• The therapist believes direct physical examination, hands-on help, specific equipment or close supervision is needed.
• The therapist cannot see or assess the relevant movement reliably by video, or communication and technology make the session ineffective.
• You feel unsafe completing an activity without someone physically present.
• A new concern, worsening symptoms or a change in your condition needs prompt professional assessment.

Access, privacy and safety deserve a place in the decision

Access: Video can reduce travel and scheduling burdens for some people, but it also depends on a device, connection, digital confidence, language and accessibility support. Ask the clinic what help is available if you have a small screen, limited data, hearing or vision needs, or no private room. The 2024 review's attendance estimate was uncertain, so convenience should be considered individually rather than assumed. (Review)

Privacy: Before a remote appointment, ask what platform the clinic uses, who can access the session or records, how information is stored, and whether the session is recorded. Take the call somewhere you feel comfortable speaking. A caregiver can join if you want their help, but agree on their role with the therapist.

Safety: Ask the physiotherapist how they will observe movement, what to do if the connection drops, whether another person should be nearby for a particular activity, and how to arrange an in-person appointment if remote assessment is not enough. A remote appointment should not prevent you from being referred for direct assessment when the clinician thinks that is needed. The APTA guideline addresses benefits, harms and implementation, but it does not give a single public rule that assigns every patient to one format. (APTA guideline)

Limits of the evidence

The findings summarized here cover different questions. REFORM tested a specific, six-week supported remote program against usual outpatient care in 210 adults with musculoskeletal conditions. The video review pooled attendance, exercise adherence and satisfaction across adults and multiple studies; it did not establish that pain or physical function outcomes are interchangeable across delivery formats. The review authors rated certainty very low to low. Neither source supports a universal statement that virtual, hybrid or in-person physiotherapy is always equal or superior.

Evidence may not apply to children, complex or changing conditions, people who need close physical assistance, or those without adequate technology or support. APTA's guideline is broader, but its summary is not an individual assessment or a patient-specific triage protocol. Your needs, goals, preferences and response to care should guide the discussion with your physiotherapist.