Delivering Musculoskeletal Rehabilitation in the Digital Era: A Perspective on Clinical Strategies for Remote Practice.

The purpose of this perspective is to present a structured framework for delivering musculoskeletal (MSK) care via telerehabilitation, advocating for a fundamental shift in the mindset of physical therapists. Rather than viewing virtual care as a limited substitute, it is redefined as a clinically valid model that requires deliberate reengineering of traditional assessment and treatment practices. The article addresses three key questions: (1) How can MSK assessment and treatment be effectively delivered in the digital environment? (2) What clinical reasoning pathways can guide patient triage in virtual care? and (3) What value does telerehabilitation offer to both patients and therapists? The article outlines how MSK sessions can be conducted remotely through a systematic approach to preparation, subjective examination, and physical assessment, each adapted to both the constraints and opportunities of the digital environment. Core elements of in-person care are translated into telehealth-compatible formats, including visual observation, patient-guided special tests, and digitally administered patient-reported outcome measures. It further proposes clinical decision pathways that enable therapists to triage patients into three categories: those fully suitable for telehealth, those requiring hybrid care, and those needing referral. The value proposition of MSK telerehabilitation is discussed from both the patient and therapist perspectives, highlighting enhanced accessibility, efficiency, and patient empowerment. The article contrasts the in-person and telerehabilitation models, underscoring the elevated importance of communication, creativity, resourcefulness, and clinical reasoning in virtual contexts. Beyond current challenges such as regulatory ambiguity, reimbursement variability, and digital inequity, the article explores future directions for MSK care. These include integration of wearable technologies, AI-assisted assessments, and an evolving therapist role as a director of care within a digitally enabled system. Ultimately, this article offers not just a model for virtual MSK sessions, but a vision for sustainable, evidence-informed transformation in rehabilitation delivery.