(Mar. 2, 2022) In coordination with the DHA Virtual Medical Center Europe (VMC-E) and operational units with Operation Atlantic Resolve in USEUCOM, Active Duty physical therapists from U.S. Naval Readiness and Training Commands (US NMRTC) Sigonella and Naples have developed a Virtual Physical Therapy Clinic (VPTC). This innovative clinic delivers musculoskeletal evaluation and care to forward deployed Active Duty service members (ADSM) ashore and afloat.

Thirty-five medical and surgical specialties in Europe, primarily located at Landstuhl Regional Medical Center in Germany, have been providing virtual consultation to service members in remote, operational, and embassy settings using the Tricare International SOS (ISOS) referral system. However, Physical Therapy (PT) consultation services have not been offered until now. Musculoskeletal injuries are the leading cause of clinic visits by Sailors, Soldiers, Airmen, and Marines representing two-thirds of all limited duty profiles. Additionally, more than 80% of all musculoskeletal (MSK) injuries are due to overuse, with lower extremity overuse injuries listed as the #1 cause of lost and limited workdays. Non-combat MSK injuries associated with back, neck, and extremity pain accounted for more than 75% of all medical evacuations from the OIF/OEF Theater(s). A deployed physical therapist on-site is preferred and has been shown to improve return to duty and MSK injury outcomes—but this is not feasible at every location.

Lt. Cdr Karla Krasnoselsky (physical therapist) from US NMRTC Sigonella led the effort and met with Rear Adm. Bruce L. Gillingham, the Navy Surgeon General and Lt. General Place, the Director of the Defense Health Agency (DHA), to showcase her team’s efforts in taking physical therapy to deployed warfighters at locations without access to physical therapy.

“Military medicine’s mission is to conserve the fighting strength of all our service members. This means keeping warriors on-site and ready to fight without jeopardizing their readiness and health,” said Lt. Cdr Krasnoselsky. “Often in forward deployed locations there is no access to musculoskeletal experts. This new Virtual Physical Therapy Clinic offers forward deployed embedded medical providers an opportunity to work closely with worldwide VMC-credentialed Physical therapists to offer services and ensure care is appropriate for the patient’s diagnosis while maintaining quality and safety”.

Using Department of Defense approved video platforms, 75 virtual PT patient encounters have been completed to date in 2022. Patients receiving services are primarily Army soldiers forward deployed at Role I and II sites in Poland, Romania, and Bulgaria.
Deputy Surgeon CPT Ryan Hunton with 1 CD FWD in Poznan, Poland was the first provider to partner with Lt. Cdr Krasnoselsky on this unique venture. “Our remote Aid Station sees a lot of Soldiers with musculoskeletal issues” said CPT Hunton. “Ultimately, keeping Soldiers engaged and focused on the mission is the goal. The virtual health physical therapy service has definitely been a big part of us achieving this goal for several cases. During much of my time deployed to Poland, I did not have easy access to physical therapy for Soldiers. However, now that we have been using this service for several months, I cannot imagine not having this resource available. It is a force multiplier; both the medical staff and the patients love it.”
Another example of a unique patient encounter was when US NMRTC Naples Physical Therapy department responded to a unique request to provide virtual physical therapy services to a Sailor assigned to the USS Mount Whitney (LCC-20) – while underway. Understanding the importance of continuing injury rehabilitation and keeping the ship on the mission, Lt. Raymond Blasi (physical therapist) coordinated SIPR VTC access and provided a synchronous telehealth physical therapy treatment session for the patient while underway.

This is the first time Secure VTC has been used to conduct physical therapy care with a ship underway and is the next phase of a larger effort to coordinate care with operational units in remote areas. Feedback from the patient was positive stating, “The care was great, but beyond that I think today was a huge win. We did distance medical from one Fleet AOR to another. Awesome! USS Mount Whitney is all in to keep pushing for this in whatever format we can make happen.”

Physical therapy services delivered virtually to the warfighter shows clinical efficacy and diminishes geographic constraints to improve availability of specialty care. Though not as ideal as having a physical therapist on-site, the Virtual Physical Therapy Clinic (VPTC) option leverages modern technology and extends musculoskeletal management to the warfighter to keep them in the fight and improves forward medical readiness.