Physical Therapist Perspectives on the Use of Telehealth with First Nations Peoples in Canada: A Qualitative Study.

Objective: This study aims to explore physical therapists' perspectives on providing physical therapy to First Nations peoples in Canada via telehealth, specifically to understand 1) their perspectives on the feasibility of telehealth as a medium for health care delivery and 2) their experiences building trusting therapeutic relationships via telehealth care.

Methods: This study included 13 physical therapists who provided clinical care via telehealth for First Nations individuals in northern British Columbia in the past 3 years, and 7 master of physical therapy students undergoing or who completed their Indigenous Health clinical placement in the past 3 years and utilized telehealth. In-depth semi-structured interviews were conducted. Interview questions explored: telehealth usage and acceptance, experiences with telehealth, and overall recommendations for telehealth. Audio recordings were transcribed, and reflexive thematic analysis was conducted.

Results: Three overarching themes were identified: "Telehealth can make a huge difference, but it is widely underutilized;" "Telehealth is a little bit less personal and in-depth;" and "There is a time and place for telehealth."

Conclusion: Telehealth shows promise in the delivery of physical therapist services to First Nations communities in Canada, enhancing accessibility, offering flexible scheduling options, and optimizing therapist time efficiency. However, successful implementation in these communities is contingent upon addressing several challenges, including building trusting therapeutic relationships. Technological glitches, the absence of physical interaction, and a history of trauma may hinder the development of the therapeutic relationship in telehealth encounters. To mitigate these challenges, cultural safety training, initial in-person appointments, community familiarity, and in-person support from a caregiver or other health care provider may play pivotal roles.

Impact: This study not only sheds light on the underutilization of telehealth but also underscores its potential to significantly improve the accessibility and efficiency of physical therapist services to First Nations peoples in Canada. The findings emphasize the nuanced dynamics of therapeutic relationships in telehealth, offering critical insights for the integration of culturally sensitive practices. Addressing the challenges pinpointed can enhance the quality of telehealth care for First Nations individuals, promote more equitable healthcare delivery, and foster positive health outcomes.