Rethinking traditional physiotherapy: Tim Barsellotti's online practice

The COVID-19 pandemic left many allied health clinics scrambling to adapt to practising online. Having opened a 100% online physiotherapy clinic in 2019, just before the pandemic hit, Tim Barsellotti found himself in a fortunate position. By the time lockdowns and restrictions were being implemented around the world, he was already equipped to treat patients remotely and – having snapped up theonlinephysiotherapist.com – had an enviable domain name!

We were excited when Tim agreed to have a chat to us about his experiences running a fully online physio practice. Whether you’re wanting to move your clinic either fully or partially online, or if you’re just interested in ways to incorporate more technology into your practice, Tim has some valuable insights.

Tim’s background

In addition to a love of sports, a sense of social conscience guided Tim towards physiotherapy. Tim was an athletic kid growing up and throughout his studies at The University of Birmingham, where he was Chairman of Sports. Even now, when he isn’t spending time with his wife and baby daughter, you’re likely to find him running, playing tennis, or hiking a mountain in Wales or the Peak District. But a passion for sport wasn’t his only motivation for wanting to become a physio – he’d first become interested in the profession on a trip to India during his teenage years. In Bangalore, he witnessed the direct impact that physiotherapy was having in the lives of local children with developmental delay and knew he wanted to contribute in a similar way.

After working in the profession for several years, the idea for the Online Physiotherapist came when Tim was leaving South Sudan in 2018. During the year that he and his wife (a leadership consultant) lived there, Tim opened the only physiotherapy clinic in the capital, Juba, and lectured at the university. In his spare time he worked pro bono in the Protection of Civilians (POC) camps, which protect South Sudanese people seeking refuge from the civil war, and began to train the therapy workers there in physiotherapy.

The experience of working in South Sudan prompted an epiphany, which radically changed Tim’s entire approach to his practice – he realised he could provide help to patients without needing to be there in-person. As he says, “the power of physiotherapy and recovery is in the knowledge and experience of the physio.The combination of precise questioning to hit your diagnosis, paired with the creation of an active-based rehab programme, evidence-based advice, and technology, is a winning formula for a fast recovery.” If these are the primary factors that aid rehabilitation from injury, Tim figured that the physio process could easily occur remotely. Feeling inspired, he returned home to London and made the leap of faith to set up his online clinic – which has now been open for over three years!

The surprising benefits of running a fully online physio clinic

Physios have mixed attitudes towards seeing patients remotely. A recent survey we conducted found that, while 38% of physios regularly use Telehealth, 40% resort to it only when COVID-19 restrictions are in place and 20% elect not to use it at all. However, remote physiotherapy has been highly effective to an extent that has even taken Tim by surprise! “Online physio is leading to us typically seeing quicker results than in person physio which, although it has some clear reasons behind it, is mind-boggling even for me,” he reflects.

So how does a fully online physio practice work? Tim says a diagnosis can almost always be reached remotely, simply by asking precise questions – exactly the way a physio would in a clinic. The injury is further assessed through examination, observation, and testing, and a functional movement analysis confirms the diagnosis. Once the issue has been identified, Tim will then develop a recovery program that patients can do at home.

Some injuries respond particularly well to online treatment. Tim has noticed that sports injuries and post-operative patients make exceptional progress with solely online care. There are also specific ailments, such as pelvic health issues, achilles tendinopathy, shoulder impingements, and lower back pain, which have all proved particularly receptive to remote physiotherapy. But patient commitment is fundamentally what determines how well someone will do with online treatment. Tim notes that the best success is achieved by dedication, “it’s patients who can commit 15 to 30 minutes a day to their recovery and listen to the advice given. It’s quite simple, but it’s hard for people to integrate rehab into their day to day. We run so fast in life, don’t we?” We couldn’t agree more. And, sadly, when people get busy, their own health and wellbeing often seems to be the first thing to drop down the priority list.

Increased accessibility is a key benefit to running a fully online practice and this is one of the aspects Tim has enjoyed most. “I get to help people from all over the world, in all walks of life who wouldn’t usually be able to access healthcare and I just think that’s one of the greatest joys and privileges,” he says. In this age of global connectedness, access to specialised healthcare doesn’t have to be reserved for a wealthy few. True to Tim’s vision, the Online Physiotherapist attracts a genuinely diverse clientele – patients range in age from 12 to 94 and, to date, the clinic has seen people across 17 different countries. Tim has used translators when necessary to help with a language barrier, or even resorted to a good old fashioned telephone call if internet connectivity is a problem! The online setting offers flexibility to adapt to patient needs. And, in a nice example of coming full circle, Tim has even treated online patients from South Sudan.

The challenges of a new approach

Being a fully online clinic has had its share of challenges. An online approach is sometimes controversial, with some people believing that traditional hands-on physiotherapy is essential to recovery. Tim sees part of his role as working towards changing perceptions around this outdated view. “[It’s about] the education of people who believe that in-person physiotherapy is the only way to get maximal recovery – that they need to be touched or massaged to get better,” he tells us. “Because what I’ve found, and speaking to other online physios, that’s not the case.”

Although Tim acknowledges that physical touch can be beneficial, the number of patients who require this for their recovery is minimal: “Empirically there’s around 85-90% of injuries that can be treated as effectively online and about 10-15% that you need in person.” If this is what a patient truly needs, Tim will happily direct them to a local Physio clinic that offers in-person services (or occasionally sees them himself), but it isn’t the focus of his practice – nor is it necessary for most patients.

Rather than online physiotherapy being lesser, Tim sees it as offering patients increased autonomy over their own recovery. For Tim, “online physio takes an unhealthy focus away from the physio doing all the work. The patient is educated, guided, and empowered to play a crucial part in their recovery like never before.” This is in addition to the practical benefits of reduced time sitting in traffic or a waiting room, and the convenience of being able to fit an appointment into a work schedule.

Patient responses to online physiotherapy are mixed. Some people simply won’t be persuaded that a fully online practice has merit, while others embrace the new possibilities this approach offers. This is sometimes divided across generational lines – Tim observes that younger people are generally more comfortable to integrate technology into their life in new ways, while the older generation is somewhat more likely to have doubts. “Which is fine,” Tim says. “I’m not trying to prove anything. I acknowledge that for some, [in-person physio] is their preference, and I respect that.”

Tim’s essentials for running a fully online physio practice

You might think that running an all-online practice must involve a lot of high-tech equipment, but Tim keeps things quite simple and streamlined. He shared his three essentials with us:

1A high-quality webcam and good lighting

Tim recommends making sure that you’re as visible as possible to your patients. If they can see you clearly, it’s much easier to demonstrate exercises and show anatomical models. Good visibility also helps with non-verbal cues, which can play an important role in communication. If you want some more tips on making your Telehealth set-up as effective as possible, you might find this guest blog post helpful.

2Physical and digital anatomical models

Exactly the same as in clinic, anatomical models (of the knee, ankle, shoulder etc.) are helpful to explaining a diagnosis over camera in a way that’s visually accessible. Tim has found that these replicas are particularly effective when communicating via a screen and show even greater anatomical detail when you digitally zoom in.

3Practice management software

This wasn’t initially on Tim’s list of essentials – when he first built his website it didn’t seem necessary. “My web developer had built a booking system for me, so that’s just what I used,” he admits. But when he was updating his website in 2021, Tim decided to look for practice management software. He did a lot of market research before ultimately deciding to use Cliniko – signing up after undertaking a trial offer for the Chartered Society of Physiotherapy (CSP) members. He used his trial period wisely, making sure he could get a proper feel for the platform and sussing out our support team. We’re totally on board with that! We always suggest you try us out with a free trial if you’re thinking about using Cliniko.

Choosing practice management software

It’s important to know what you’re looking for from practice management software. Tim had a clear idea as to what he needed: a fully automated booking system, online treatment notes, the ability to track marketing and growth, and a way to deal with practitioners and patients being in different time-zones. We’re very happy that Cliniko provided a way for him to address these issues! He also shared three additional aspects of the Cliniko platform that have been particularly useful for running an online practice:

1Timezone tracker

This is especially important when Tim’s service is so international. When patients book in, they can see the available appointments listed in their local time and book into a slot that works for them (rather than having to do complicated calculations to translate Greenwich Mean Time into their own time zone!). Tim remarks there are far fewer missed appointments this way: “the worst thing is to be needing your physio appointment and then missing it.”

2Online patient forms

As well as being a time-saving mechanism (the beginning of sessions doesn’t have to be spent filling in information if patients can do this ahead of time), having online forms also prevents patients being put on the spot. As Tim says, “you give people an opportunity to really think on something rather than feel pressured to give an answer straight away.”

3Exercise prescription integration:

There are many options for exercise prescription software – have a browse through our connected apps page to see which ones integrate with Cliniko. Exercise prescription platforms allow a practitioner to create and share a physio program digitally, saving time and simplifying the experience of remote rehab for patients. Tim has noticed these programs have a positive effect on patients’ recovery by increasing adherence to their rehab program, giving them a clear focus of what they need to do, and tapping into a person’s self-competitiveness to keep improving their outcome measures or symptom scores.

If what you need from practice management software isn’t quite as clear-cut for you as it was for Tim, we recommend exploring what’s out there and asking yourself the following questions about whether a particular platform is right for you. Taking the time to do the research now could save yourself some frustration in the long run!

We’re super grateful to Tim for taking the time to speak with us. We hope his story has given you some food for thought as to how you could incorporate more technology into your treatments or expand the digital presence of your clinic. It’s wonderful that it’s now possible for physios and other allied health professions to practice in so many diverse ways. Whether your clinic is completely in-person, fully online, or somewhere in between, there will be a patient base that resonates with your ethos. And we love it when Cliniko gets to be a part of what you do.