Article discusses the challenges of telerehabilitation for chronic patients during the pandemic
By Otávio Gomes*
Photo: Freepik
The PilatesAR outreach project at the Federal University of Espírito Santo (UFES) adapted its in-person activities for remote modalities and served 162 women with chronic musculoskeletal pain between 2020 and 2021. A study published in issue No. 19 of the Guará Journal evaluates the strategies used by the project to maintain the therapeutic relationship and preserve the patients’ physical function during the period of social isolation imposed by the COVID-19 pandemic.
Created in 2018 to offer free Pilates sessions to patients with rheumatoid arthritis (RA), PilatesAR transitioned to synchronous classes via videoconference (Google Meet) and monitoring via WhatsApp after UFES suspended in-person activities in March 2020. The project conducted 56 telehealth sessions divided into three phases and involved the participation of 30 undergraduate students, two administrative physical therapy technicians, and one external physical therapist.
The initiative took place at a time when online physical therapy in Brazil received exceptional authorization from the Federal Council of Physical Therapy and Occupational Therapy (COFFITO) following the WHO’s declaration of a pandemic, ensuring legal backing for teleconsultation, telecounseling, and telemonitoring services.
RA is an autoimmune disease that can lead to disability. Although there are still few specific studies on Pilates in the treatment of RA, recent evidence suggests that the Pilates method is a useful form of physical therapy for improving pain, muscle endurance, and quality of life in patients with chronic pain.
To make remote practice feasible, the in-person protocol was adapted for low-cost home practice: standing exercises with a low risk of falling, replacing the Swiss ball with a chair, and using 600-ml PET bottles in place of resistance bands. Classes were held twice a week, lasting one hour each. In the classroom, an instructor demonstrated the exercises, and four students monitored posture and form, offering real-time corrections.
Before and after each stage, participants underwent assessments via videoconference, which included medical history, lifestyle habits, medication use, physical activity, and standardized instruments. In addition to the classes, the team created a WhatsApp group for feedback, to send educational materials each week, and to monitor symptoms. Two e-books were developed and distributed to patients for educational purposes: one with guidelines for teleconsultations and another with an illustrated exercise protocol.
A total of 162 women enrolled in the project; 35 dropped out during the process. Among the difficulties reported were problems with equipment (such as cell phone use and lack of internet access), an inadequate home environment, and difficulty understanding the exercises. As a benefit, the telehealth service expanded access, allowing women from other cities and states to participate and reducing barriers related to travel and dependence on public transportation.
The study concludes that telerehabilitation not only maintained the minimum level of physical activity necessary to preserve the patients’ functionality but also showed potential for increasing access to rehabilitation services. Despite the greater physical distance and the weakening of the bonds that existed in in-person care, the project team sought to implement communication strategies and continuous monitoring to maintain interest in the classes. According to the authors, the shift to telehealth ensured continuity of care at a critical time, reducing the risk of patient deterioration and expanding the project’s reach, although it requires additional strategies for support and digital inclusion.
*Intern under the supervision of Paola Primo
